Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis.
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.


OBJECTIVE
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).


CONCLUSIONS
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.
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium. davy.vancampfort@uc-kortenberg.be.|KU Leuven-University of Leuven, University Psychiatric Centre, 517 Leuvensesteenweg, Kortenberg, 3070, Belgium. davy.vancampfort@uc-kortenberg.be.
Davy
D
Vancampfort
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Simon
S
Rosenbaum
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.|Programa de Pos Graduacaoem Ciencias Medicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Felipe
F
Schuch
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Philip B
PB
Ward
School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
Justin
J
Richards
Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
James
J
Mugisha
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
Michel
M
Probst
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Brendon
B
Stubbs
D015992:Body Mass Index; D000072599:Cardiorespiratory Fitness / Q000502:physiology*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D006801:Humans; D010809:Physical Fitness / Q000502:physiology* / Q000523:psychology; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index