Background

Patients with severe mental illness face a risk of premature death, approximately 15–20 years earlier than the general population, primarily due to cardiovascular diseases. Mental illness and genetics are known risk factors for developing cardiovascular diseases. Mental illness (e.g., suicide risk) and various environmental factors, such as antipsychotic medication, lifestyle, and physical inactivity, further increase the risk of cardiovascular diseases. Physical fitness can predict the risk of developing cardiovascular diseases and mortality in the general population, but fitness is rarely measured or considered in psychiatric care. Consequently, the extent to which poor fitness contributes to the high prevalence of cardiovascular diseases and premature death in patients with severe mental illness remains unclear.

Aim

This project aims to investigate whether it is feasible, valid, and clinically relevant to systematically measure fitness in patients with severe mental illness.​

Methods, Design, and Study Procedures

The research project comprises three parts:

1. Systematic review and meta-analysis based on studies measuring fitness and related parameters (e.g., physical capacity) to determine fitness levels and testing methods used in studies of individuals with severe mental illness.

2. Clinical cross-sectional study.

3. Association study utilizing data from two ongoing randomized controlled trials (Project Vega and Meta Care Clinic) to examine the relationship between fitness and other parameters such as quality of life, personal recovery, cognition, etc.

The clinical cross-sectional study includes individuals aged 18–45 with severe mental illness (schizophrenia, schizotypal disorder, other schizophrenia spectrum disorders, severe depression, and bipolar affective disorder) who are on antipsychotic medication. Control participants without mental illness and no first-degree relatives with mental illness can also participate. Control participants are matched to patients by BMI, age, and gender.

Participation involves a 3-hour visit at Psychiatric Center Glostrup, where initial physical measurements are taken. Participants will undergo assessments of psychopathology and cognition, complete questionnaires about physical activity levels, perceived fitness, and quality of life, and perform an 8-minute mild-to-moderate fitness test on a stationary bike. This test is non-exhaustive and aims to validate a simple fitness test. Following this, participants will complete a high-quality fitness test involving physical exertion to measure maximum oxygen uptake. This 8–12 minute test starts easy and becomes progressively harder. Participants will also wear a physical activity sensor for 12–14 days.
Overall, participants will gain comprehensive insights into their physical health and capacity, which may provide information about their cardiovascular risk. If interested, participants can discuss their results in relation to diet and exercise habits.

Study Participants

Heart in Mind aims to include 50 participants with severe mental illness and 25 control participants.

Inclusion criteria:

• Aged 18–45

• Severe mental illness

  • F2.X (schizophrenia spectrum disorder)

  • F31 (bipolar affective disorder)

  • F32 (severe depression)

• Receiving a stable daily dose of antipsychotic medication (≥1 month)

• Able to provide informed consent

Exclusion criteria:

• Acute increased suicide risk

• Unstable mental illness

• Clinical or laboratory evidence of untreated physical illness
  

Perspectives

Validation of a simple fitness test will enable the identification and monitoring of patients with poor fitness and an increased risk of cardiovascular diseases. This project and its clinical implementation will not only assess whether low fitness is a contributing factor to the elevated cardiovascular risk among patients with severe mental illness but may also promote physical health and prevent premature death in this population.

Contact

Victor Sørensen
PhD student, MSc in Human Physiology
Email: victor.soerensen@regionh.dk

Funding

Heart in Mind is financially supported by The Simon Fougner Hartmann Family Foundation with DKK 556,065 (grant number: 2023-0065) for the purchase of oxygen uptake equipment and physical activity sensors (secured by Victor Sørensen).

Institutional Affiliation

The study is conducted at Psychiatric Center Glostrup under CARMEN and the Center for Neuropsychiatric Schizophrenia Research (CNSR).

This PhD project is carried out by Victor Sørensen.

Main Supervisor: Professor and Psychiatrist Bjørn H. Ebdrup (CNSR)
Primary Co-supervisor: Professor and Psychologist Julie Midtgaard (CARMEN)
Co-supervisors:

• Professor and Human Physiologist Nikolaj B. Nordsborg (Department of Nutrition, Exercise, and Sports, University of Copenhagen)

• Professor and Psychiatrist Margaret Hahn (Complex Care and Recovery, Schizophrenia Division, Center for Addiction and Mental Health, Toronto, Canada)
  

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