PHYSICO-DSM-VR Physical health promotion in patients with functional psychoses of the 4 Community Psychiatric Services of ULSS 20, Verona: a multicentre Randomised Controlled Study

Background Literature on physical comorbidity in psychosis shows that, in comparison to the general population, patients with severe mental illness (such as schizophrenia and bipolar disorder) have worse physical health and a far shorter life expectancy. These findings have been explained with a multi-causal model including a higher prevalence of risk factors like high blood pressure, high plasma cholesterol and obesity, smoking, diabetes, tendency to self neglect, unhealthy lifestyles, medication side-effects and low socio-economical status, hence including risk factors that are inherently non-modifiable (gender, age, family history) and risk factors that are modifiable through behavioural changes and improved care (smoking, obesity, diabetes, hypertension and dyslipidaemia). In the last years, in particular, specific or adapted intervention programmes to change unhealthy lifestyles through diet and/or physical activity modifications are being developed. Preventive and individual lifestyle interventions that include diet and physical activity should be taken into account when treating schizophrenic patients with antipsychotics. Objectives The general objective of the trial is to implement health promotion strategies on dietary habits and physical exercise and to study their efficacy with a randomised controlled trial in patients with functional psychoses referred to the 4 Community Psychiatric Services (CPSs) of ULSS 20 (Verona). The main hypothesis is that the intervention package will result in the improvement of physical activity and diet-related behaviours in people with functional psychoses, compared to those receiving treatment as usual. Secondary hypotheses are the improvement of examined physical health parameters, health-related quality of life and patients satisfaction with the psychiatric services. Methods The intervention package (6 months) consists in: health education sessions for patients on physical activity and nutrition; group walking under the guide of an expert trainer; educational sessions for the mental health workers involved; motivational interviewing to promote adherence. Subjects have been tested at baseline and after the end of treatment on: physical health status, physical activity and diet habits, number of steps during walking groups, health-related quality of life, patients satisfaction with CPS. The primary outcome is based on WHO recommendations on diet and exercise (at least five servings of fruit and/or vegetables a day; moderate physical activity for at least 30 minutes on at least 5 days a week). The improvement of at least one WHO criterion at the final assessment compared to the initial one will be considered a successful change. Results In the experimental group, 40.57% (71/175) of subjects fulfil one criterion more at follow-up than at baseline, while 32.35% (55/170) of subjects of the control group do. The difference between groups is not significant (χ2(1) = 2.51, p = 0.11). When diet and physical activity are analysed separately according to subjects participation to the intervention (>60% of sessions attended), participants show a significant increase in the number of fruit/vegetables portions per day (+ 0.3) and in the number of minutes of moderate physical activity (+ 80) per week. Conclusions Results of this trial and the observational phase of the study correspond with the alarming situation reported by literature on the increased risk factors, physical morbidity and mortality of psychiatric patients. Results on specific aspects of the intervention revealed a significant difference in diet and physical activity habits in subjects who participated to a sufficient number of sessions. The principal issue is actually engaging this kind of population in a lifestyle intervention. Once engaged they can benefit from it, although to reach a significant change an intervention of this kind needs further improvement and refined methods.