Browsing by Author "Firth, Joseph"

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Cardiorespiratory fitness levels and moderators in people with HIV: a systematic review and meta-analysis
(Elsevier: Preventive Medicine, 2016-12) Vancampfort, Davy; Mugisha, James; Rosenbaum, Simon; Firth, Joseph; De Hert, Marc; Probst, Michel; Stubbs, Brendon
Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4 ml/kg/min (95% CI = 24.6 to 28.1) (n = 1010; mean age = 41 years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β = − 0.99, 95% CI = − 1.93 to − 0.06, P = 0.04), older age (β = − 0.31, 95% CI = − 0.58 to − 0.04, P = 0.02) and the presence of lipodystrophy (β = − 4.63, 95% CI = − 7.88 to − 1.39, P = 0.005) were significant moderators of lower CRF levels. Higher CD4 + counts (β = 0.004, 95% CI = 0.0007 to 0.007, P = 0.016), supervised interventions (P < 0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P < 0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.
Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries
(Springer Link: International Journal of Behavioral Nutrition and Physical Activity., 2017-01-18) Vancampfort, Davy; Koyanagi, Ai; Ward, Philip B.; Rosenbaum, Simon; Schuch, Felipe B.; Mugisha, James; Richards, Justin; Firth, Joseph; Stubbs, Brendon
There are no nationally representative population-based studies investigating the relationship between physical activity, chronic conditions and multimorbidity (i.e., two or more chronic conditions) in low- and middle-income countries (LMICs), and studies on a multi-national level are lacking. This is an important research gap, given the rapid increase in the prevalence of chronic diseases associated with lifestyle changes in these countries. This cross-sectional study aimed to assess the association between chronic conditions, multimorbidity and low physical activity (PA) among community-dwelling adults in 46 LMICs, and explore the mediators of these relationships. Methods World Health Survey data included 228,024 adults aged ≥18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ). Nine chronic physical conditions (chronic back pain, angina, arthritis, asthma, diabetes, hearing problems, tuberculosis, visual impairment and edentulism) were assessed. Multivariable logistic regression and mediation analyses were used to assess the association between chronic conditions or multimorbidity and low PA. Results Overall, in the multivariable analysis, arthritis (OR = 1.12), asthma (1.19), diabetes (OR = 1.33), edentulism (OR = 1.46), hearing problems (OR = 1.90), tuberculosis (OR = 1.24), visual impairment (OR = 2.29), multimorbidity (OR = 1.31; 95% CI = 1.21–1.42) were significantly associated with low PA. More significant associations were observed in individuals aged ≥50 years. In older adults, depression mediated between 5.1% (visual impairment) to 23.5% (angina) of the association between a chronic condition and low PA. Mobility difficulties explained more than 25% of the association for seven of the eight chronic conditions. Pain was a strong mediator for angina (65.9%) and arthritis (64.9%), while sleep problems mediated up to 43.7% (angina) of the association. Conclusions In LMICs, those with chronic conditions and multimorbidity are significantly less physically active (especially older adults). Research on the efficacy and effectiveness of PA in the management of chronic diseases in LMICs is urgently needed. Targeted promotion of physical activity to populations in LMICs experiencing chronic conditions may ameliorate associated depression, mobility difficulties and pain that are themselves important barriers for initiating or adopting an active lifestyle.
Correlates of sedentary behavior in 2,375 people with depression from 6 low- and middle-income countries
(Elsevier : Journal of effective Disorders., 2018-07) Vancampfort, Davy; Stubbs, Brendon; Mugisha, James; Firth, Joseph; Schuch, Felipe B.; Koyanagi, Ai
Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries. Methods Cross-sectional data from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses. Results In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary. Conclusion Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account.
The efficacy of meditation-based mind-body interventions for mental disorders: a meta-review of 17 meta-analyses of randomized controlled trials
(Elsevier: Journal of Psychiatric Research., 2021-02) Vancampfort, Davy; Stubbs, Brendon; Van Damme, Tine; Smith, Lee; Hallgren, Mats; Schuch, Felipe; Deenik, Jeroen; Rosenbaum, Simon; Ashdown-Franks, Garcia; Mugisha, James; Firth, Joseph
There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.
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).
Leisure-time sedentary behavior and suicide attempt among 126,392 adolescents in 43 countries
(Elsevier: Journal of Affective Disorders, 2019-05-01) Vancampfort, Davy; Stubbs, Brendon; Mugisha, James; Firth, Joseph; Van Damme, Tine; Smith, Lee; Koyanagi, Ai
Adolescent suicide is a major global mental health problem. Exploring variables associated with suicide attempts is important for the development of targeted interventions. The aim of the current study was to explore associations between leisure-time sedentary behavior and suicide attempts. Methods Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and self-reported leisure-time sedentary time were collected. Multivariable logistic regression and meta-analysis were conducted to assess the associations. Results Among 126,392 students from 43 countries (mean age 13.8 ± 0.96 years; 48.9% female), 10.6% had attempted suicide. The prevalence of suicide attempts increased with increasing sedentary leisure-time per day (from 9% at <1 h/day to 16.8% at >8 h/day). Compared to those engaging in <1 h/day sedentary during leisure-time, there was a dose-dependent increase in odds ratios (ORs) for suicide attempts, with the OR for >8 h/day being 1.45 (95% confidence interval=1.19–1.77). Limitations The study is cross-sectional, therefore the directionality of the relationships cannot be deduced. Conclusions Our data suggest that leisure-time sedentary behavior is associated with increased odds for suicide attempt in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public prevention campaigns.
Physical activity and anxiety: a perspective from the World Health Survey
(Elsevier: Journal of Affective Disorders ., 2017-01-15) Stubbs, Brendon; Koyanagi, Ai; Hallgren, Mats; Firth, Joseph; Richards, Justin; Schuch, Felipe; Rosenbaum, Simon; Mugisha, James; Veronese, Nicola; Lahti, Jouni; Vancampfort, Davy
Despite the known benefits of physical activity (PA) among people with anxiety, little is known about PA levels in people with anxiety at the population level. This study explored the global prevalence of anxiety and its association with PA. Methods Cross-sectional, community-based data from the World Health Survey was analyzed. Prevalence of anxiety was estimated for 237,964 individuals (47 countries). PA was categorized as low, moderate, and high based on the International Physical Activity Questionnaire (short form). The association between PA and anxiety was assessed by multivariable logistic regression. Results The overall global prevalence of anxiety was 11.4% (47 countries). Across 38 countries with available data on PA, 62.5%, 20.2%, and 17.3% of the sample engaged in high, moderate, and low levels of PA respectively. The prevalence of low physical activity in those with and without anxiety was 22.9% vs. 16.6% (p<0.001) (38 countries, n=184,920). In the pooled model adjusted for socio-demographics, depression, and country, individuals engaging in low PA (vs. high PA) had 1.32 (95% CI=1.17–1.47) times higher odds for anxiety than those with high PA. Female sex, older age, lower education and wealth, and depression were also associated with low PA. At the individual country level, there was a significant positive association between low PA and anxiety in 17 of the 38 countries. Conclusion Low PA levels are associated with increased prevalence of anxiety. There is a need for longitudinal research to establish the directionality of the relationships observed
Physical Activity and Mental Health: A Little Less Conversation, a Lot More Action
(Journal of Physical Activity and Health, 2024-07-18) Stubbs, Brendon; Ma, Ruimin; Schuch, Felipe; Mugisha, James; Rosenbaum, Simon; Firth, Joseph; Vancampfort, Davy
Physical activity and suicidal ideation: a systematic review and meta-analysis
(Elsevier: Journal of Affective Disorders, 2018-01-01) Vancampfort, Davy; Hallgren, Mats; Firth, Joseph; Rosenbaum, Simon; Schuch, Felipe B.; Mugisha, James; Probst, Michel; Van Damme, Tine; Carvalho, André F.; Stubbs, Brendon
A potential approach to suicide prevention that has not been closely examined, but which holds promise in terms of widespread dissemination without major side-effects, is physical activity (PA). This systematic review and meta-analysis set out to: (a) explore associations between PA and suicidal ideation (SI) levels, and (b) investigate the effect of PA interventions on SI. Methods Major electronic databases were searched from inception up to 05/2017 to identify quantitative studies reporting an association between PA and SI. A quantitative correlates synthesis and random effects meta-analysis were conducted. Results Fourteen of 21 studies in adults (67%) (n = 130,737), 7/14 (50%) in adolescents (n = 539,170) and 2/3 (67%) in older adults (n = 50,745) found a significant negative association between PA- and SI-levels. Pooled adjusted meta-analysis of 14 effect sizes over eight studies and 80,856 people found that those who were “active” versus those who were “inactive” were less likely to have SI (OR = 0.87, 95%CI = 0.76–0.98). Additionally, meeting PA guidelines conferred a significant protective effect against SI (OR = 0.91, 95%CI = 0.51–0.99, P = 0.03; N studies = 3, n people = 122,395), while not meeting guidelines was associated with increased SI (OR = 1.16, 95%CI = 1.09–1.24, P < 0.001; N = 4, n = 78,860). Data from the intervention studies (N = 3, n = 121) was mixed and limited. Limitations Our findings are based mainly on cross-sectional studies, while the majority of studies did not include a rigorous physical activity assessment. Conclusions The current study suggests that higher PA levels are associated with lower SI. However, the associations observed need to be confirmed in prospective observational studies and controlled trials.
Physical activity correlates among 24,230 people with depression across 46 low- and middle-income countries
(Elsevier: Journal of Affective Disorders, 2017-10-15) Vancampfort, Davy; Stubbs, Brendon; Firth, Joseph; Hallgren, Mats; Schuch, Felipe; Lahti, Jouni; Rosenbaum, Simon; Ward, Philip B.; Mugisha, James; Carvalho, André F.; Koyanagi, Ai
There is a paucity of nationally representative data available on the correlates of physical activity (PA) among people with depression, especially in low- and middle-income countries (LMICs). Thus, we investigated PA correlates among community-dwelling adults with depression in this setting. Methods World Health Survey data included 24,230 adults (43.1 ± 16.1 years; 36.1% male) with ICD-10 diagnoses of depression including brief depressive episode and subsyndromal depression aged ≥ 18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire. Participants were dichotomised into low and moderate-to-high physically active groups. Associations between PA and a range of sociodemographic, health behaviour and mental and physical health variables were examined using multivariable logistic regressions. Results 34.8% of participants with depression were physically inactive. In the multivariate analyses, inactivity was associated with male sex, older age, not being married/cohabiting, high socio-economic status, unemployment, living in an urban setting, less vegetable consumption, and poor sleep/ low energy. In addition, mobility difficulties and some somatic co-morbidity were associated with not complying with the 150 min per week moderate-to-vigorous PA recommendations. Conclusions The current data provide guidance for future population level interventions across LMICs to help people with depression engage in regular PA.
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 activity levels and psychosis: a mediation analysis of factors influencing physical activity target achievement among 204 186 people across 46 Low- and middle-income countries
(Schizophrenia Bulletin: The Journal of Psychoses and Related Disorders., 2016-08-24) Stubbs, Brendon; Koyanagi, Ai; Schuch, Felipe; Firth, Joseph; Rosenbaum, Simon; Gaughran, Fiona; Mugisha, James; Vancampfort, Davy
Physical activity (PA) can help reduce cardiovascular disease and premature mortality in people with psychosis. However, there is a paucity of representative data on PA in people with psychosis, especially from low- and middle-income countries (LMICs). Moreover, data on subclinical psychosis and PA is absent. This study explored whether complying with PA recommendations of 150 minutes of moderate-vigorous PA per week is related to: (1) psychotic symptoms without a psychosis diagnosis (subclinical psychosis); and (2) clinical psychosis (psychosis diagnosis). A total of 204 186 participants aged 18–64 years from 46 LMICs recruited via the World Health Survey were subdivided into those with (1) no psychosis diagnosis and no psychotic symptoms in the past 12 months (controls); (2) subclinical psychosis; and (3) psychosis diagnosis. People with a psychosis diagnosis had significantly higher odds for low PA in the overall sample (OR = 1.36; 95% CI = 1.04–1.78; P = .024) and among males (OR = 2.29; 95% CI = 1.57–3.34; P < .0001) but not females (OR = 0.93; 95% CI = 0.67–1.30; P = .6712). No difference was found among those with subclinical psychosis vs controls. Mediation analyses demonstrated that mobility difficulties explained the largest amount of low PA among males (18.5%) followed by self-care difficulties (16.3%), depression (16.1%), cognition (11.8%), pain and discomfort (11.4%), interpersonal activities (8.6%), sleep and energy (7.2%), and vision (3.0%). The results from the largest dataset on PA and psychosis and first in LMICs, found that psychosis diagnosis (especially among males) but not subclinical psychosis, is associated with physical inactivity. Population level interventions seeking to increase PA among people with psychosis may help improve health outcomes.
Sedentary behavior and anxiety-induced sleep disturbance among 181,093 adolescents from 67 countries: a global perspective
(Elsevier: Sleep Medicine, 2019-06) Vancampfort, Davy; Van Damme, Tine; Stubbs, Brendon; Smith, Lee; Firth, Joseph; Hallgren, Mats; Mugisha, James; Koyanagi, Ai
Sleep problems are burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective against sleep problems in adolescents. However, the association between sedentary behavior (SB) and anxiety-induced sleep disturbance has not been investigated. Methods Using cross-sectional data from the Global school-based Student Health Survey, we explored the association between SB and anxiety-induced sleep disturbance in 181,093 adolescents [mean (standard deviation, SD) age 13.7 (1.0) years; 48.4% girls] from 67 countries, controlling for confounders (including physical activity). Adolescents reported anxiety-induced sleep disturbance during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken. Results Overall, 7.8% of adolescents had anxiety-induced sleep disturbance. The prevalence of SB was: <1 h/day 39.9%; 1–2 h/day 33.8%; 3–4 h/day 15.4%; 5–8 h/day 7.4%; and >8 h/day 3.6%. Compared to <1 h/day of SB, >8 h/day was associated with a 2.27 [95% confidence interval (CI) = 1.98–2.62] times higher odds for anxiety-induced sleep disturbance. The association was similar among both sexes. The pooled odds ratio for anxiety-induced sleep disturbance when being sedentary ≥3 h/day was 1.42 (95% CI = 1.36–1.48) with only a small degree of between-country heterogeneity (I2 = 41.4%). Conclusions Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to reduce anxiety and sleep disturbance in adolescents.
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:Official Journal of the World Psychiatric Association(WPA)., 2017-10) Vancampfort, Davy; Firth, Joseph; Schuch, Felipe B.; Rosenbaum, Simon; Mugisha, James; Hallgren, Mats; Probst, Michel; Ward, Philip B.; Gaughran, Fiona; De Hert, Marc; Carvalho, André F.; Stubbs, Brendon
People with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) die up to 15 years prematurely due to chronic somatic comorbidities. Sedentary behavior and low physical activity are independent yet modifiable risk factors for cardiovascular disease and premature mortality in these people. A comprehensive meta-analysis exploring these risk factors is lacking in this vulnerable population. We conducted a meta-analysis investigating sedentary behavior and physical activity levels and their correlates in people with severe mental illness. Major electronic databases were searched from inception up to April 2017 for articles measuring sedentary behavior and/or physical activity with a self-report questionnaire or an objective measure (e.g., accelerometer). Random effects meta-analyses and meta-regression analyses were conducted. Sixty-nine studies were included (N=35,682; 39.5% male; mean age 43.0 years). People with severe mental illness spent on average 476.0 min per day (95% CI: 407.3-545.4) being sedentary during waking hours, and were significantly more sedentary than age- and gender-matched healthy controls (p=0.003). Their mean amount of moderate or vigorous physical activity was 38.4 min per day (95% CI: 32.0-44.8), being significantly lower than that of healthy controls (p=0.002 for moderate activity, p<0.001 for vigorous activity). People with severe mental illness were significantly less likely than matched healthy controls to meet physical activity guidelines (odds ratio = 1.5; 95% CI: 1.1-2.0, p<0.001, I2=95.8). Lower physical activity levels and non-compliance with physical activity guidelines were associated with male gender, being single, unemployment, fewer years of education, higher body mass index, longer illness duration, antidepressant and antipsychotic medication use, lower cardiorespiratory fitness and a diagnosis of schizophrenia. People with bipolar disorder were the most physically active, yet spent most time being sedentary. Geographical differences were detected, and inpatients were more active than outpatients and those living in the community. Given the established health benefits of physical activity and its low levels in people with severe mental illness, future interventions specifically targeting the prevention of physical inactivity and sedentary behavior are warranted in this population.