There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
ANTECEDENTES: Las personas con enfermedad mental grave (SMI) tienen altas tasas de enfermedades crónicas y muerte prematura.
Objetivos: explorar la solidez de las pruebas para las intervenciones para reducir el riesgo de mortalidad en las personas con enfermedad mental grave.
MÉTODO: En un meta-análisis de 16 revisiones sistemáticas de estudios controlados, la mortalidad fue el resultado primario (8 comentarios). medidas fisiológicas de la salud (índice de masa corporal, el peso, los niveles de glucosa, perfil de lípidos y presión arterial) fueron los resultados secundarios (14 opiniones).
RESULTADOS: Los medicamentos antipsicóticos y antidepresivos tenían un efecto protector sobre la mortalidad, sin perjuicio de la observancia del tratamiento. programas de atención comunitaria de integración puede reducir la morbilidad física y el exceso de muertes, pero los ingredientes eficaces son desconocidos. Las intervenciones para mejorar los estilos de vida poco saludables y comportamientos de riesgo puede mejorar el perfil de factores de riesgo, pero se necesita un seguimiento más prolongado. Las intervenciones preventivas y de mejora de la atención médica para las enfermedades crónicas comórbidas pueden reducir el exceso de mortalidad, pero se carece de datos.
Conclusiones: Mejora de la adherencia a las guías de gestión de la salud farmacológicas y físicas se indica.
There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.
