title: How sedentary are people with psychosis? A systematic review and meta-analysis.
abstract: OBJECTIVE
  Sedentary behavior (SB) is an independent risk factor for cardiovascular disease and mortality. We conducted a meta-analysis to investigate SB levels and predictors in people with psychosis.
  
  
  METHODS
  Major electronic databases were searched from inception till 09/2015 for articles measuring SB with a self-report questionnaire (SRQ) or objective measure (e.g. accelerometer) in people with psychosis, including schizophrenia spectrum and bipolar disorders. A random effects meta-analysis and meta regression analysis were conducted.
  
  
  RESULTS
  Thirteen studies were eligible including 2033 people with psychosis (mean age 41.3years (range 25.1-60), 63.2% male (range 35-89%), body mass index 28.7 (range 25.9-32.1). The trim and fill analysis demonstrated people with psychosis spent 660.8min (95% CI 523.2-798.4, participants=2033) or 11.0h (95% CI 8.72-13.3) per day being sedentary. Objective measures of SB recorded significantly higher levels (p<0.001) of SB (12.6h per day, 95% CI 8.97-16.2, studies=7, participants=254) compared to self-report SB (6.85h per day, 95% CI 4.75-8.96, studies=6, participants=1779). People with psychosis engaged in significantly more SB than controls (g=1.13, 95% CI 0.496-1.77, P<0.001, n psychosis=216, n controls=159) equating to a mean difference of 2.80 (95% CI 1.47-4.1) hours per day. Multivariate meta-regression confirmed that objective measurement of SB predicted higher levels of sedentariness.
  
  
  CONCLUSIONS
  People with psychosis engage in very high levels of sedentary behavior in their waking day and current SRQ may underestimate SB. Given that SB is an independent predictor of cardiovascular disease, future interventions specifically targeting the prevention of SB are warranted.
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Williams
authors.affiliation: The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gaughran
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Craig
mesh_terms: D000328:Adult; D016208:Databases, Factual / Q000706:statistics & numerical data; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology*; D012044:Regression Analysis; D057566:Self Report
keywords: Cardiovascular disease; Lifestyle; Psychosis; Schizophrenia; Sedentary behavior