title: Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion.
abstract: BACKGROUND
  There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine.
  
  
  METHODS
  The study population consisted of 69 patients (65% women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients' PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers (n = 26), mild compliers (n = 22) and strong compliers (n = 21) with the PA recommendations included in the MMT.
  
  
  RESULTS
  Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group (p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used.
  
  
  CONCLUSIONS
  Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression.
  
  
  BACKGROUND
  This is not a clinical trial.
authors.affiliation: Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-41319, Sweden. agneta.lindegard@vgregion.se.
authors.forename: Agneta
authors.initials: A
authors.lastname: Lindegård
authors.affiliation: Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-41319, Sweden. ingibjorg.jonsdottir@vgregion.se.|Department of Food and Nutrition, and Sport Science, University of Gothenburg, PO Box 300, Gothenburg, SE-40530, Sweden. ingibjorg.jonsdottir@vgregion.se.
authors.forename: Ingibjörg H
authors.initials: IH
authors.lastname: Jonsdottir
authors.affiliation: The Swedish School of Sport and Health Sciences, University of Stockholm, Lidingövägen 1, Stockholm 1, SE-11433, Sweden. mats.borjesson@ki.se.|Department of Cardiology, Karolinska University Hospital, Stockholm, SE-17176, Sweden. mats.borjesson@ki.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Börjesson
authors.affiliation: Department of Food and Nutrition, and Sport Science, University of Gothenburg, PO Box 300, Gothenburg, SE-40530, Sweden. magnus.lindwall@psy.gu.se.|Department of Psychology, University of Gothenburg, PO Box 500, Gothenburg, SE-40530, Sweden. magnus.lindwall@psy.gu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindwall
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, Basel, CH-4052, Switzerland. markus.gerber@unibas.ch.
authors.forename: Markus
authors.initials: M
authors.lastname: Gerber
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D002055:Burnout, Professional / Q000150:complications; D003863:Depression / Q000628:therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D005222:Mental Fatigue / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D040242:Risk Reduction Behavior; D013315:Stress, Psychological / Q000150:complications*; D016896:Treatment Outcome