Background
Patients with severe mental illness are at risk of dying 15-20 years earlier than the general population, which is primarily due to cardiovascular diseases. Besides the psychopathology of mental illness and genetics, several environmental factors, such as antipsychotic medication, lifestyle, including physical inactivity, increase the risk of cardiovascular diseases. Cardiorespiratory fitness can help predict the risk of developing cardiovascular diseases and death in the general population, but fitness is rarely measured or considered in psychiatric treatment. Therefore, it is unknown to what extent poor cardiorespiratory fitness contributes to the high prevalence of cardiovascular diseases and early death in people with severe mental illness.
Objective
This project aims to investigate whether it is possible, valid, and clinically relevant to systematically measure cardiorespiratory fitness in patients with severe mental illness.
Method, design, and study procedures
The research project consists of three parts: 1) A systematic review and meta-analysis that will be based on studies measuring cardiorespiratory fitness and other fitness differentiations (such as physical capacity) to uncover previously measured fitness levels and test methods used in studies of people with severe mental illness, 2) a clinical cross-sectional study, and 3) an association study using data from two ongoing randomized controlled trials, Project Vega and Meta Care Clinic, where the relationship between fitness and other parameters such as quality of life, personal recovery, cognition, etc., will be examined.
The clinical cross-sectional study is including people aged 18-45 with a severe mental illness (schizophrenia, schizotypical disorder, or other disorders within the schizophrenia spectrum, as well as severe depression and bipolar affective disorder) who are being treated with antipsychotic medication. Control persons that do not have a mental illness and none of their first-degree relatives have a mental illness. Control persons will be matched with included persons with severe mental illness based on BMI, age, and gender.
Participation involves visiting the Psychiatric Center Glostrup for a visit of approximately three hours, where physical assessments will initially be carried out, followed by assessments of psychopathology and cognition. Participants will also answer questionnaires about physical activity level, self-perceived fitness, and quality of life. The main part of the visit will then begin, where participants will perform a mild-to-moderate fitness test lasting 8 minutes on an ergometer bike, which will not feel exhausting or strenuous. This is the test that the study aims to validate. This is done by having participants subsequently undergo a state-of-the-art cardiopulmonary exercise test, where they will experience physical exertion while we measure rate of oxygen uptake. The test takes 8-12 minutes and starts very easily and then gradually becoming harder. Finally, participants will wear a physical activity sensor for the following 12-14 days. Overall, participants will gain an in-depth insight into their own body's health and capacity, as each test and the whole process can provide insight into the risk of cardiovascular diseases. Participants will also be offered the opportunity to discuss the measurements with a focus on relating them to their own diet and exercise habits, if interested.
Participants
In total, Heart in Mind aims to include 50 people with severe mental illness and 25 people without mental illness.
Inclusion Criteria
- 18-45 years old
- Severe mental illness
- F2.X (schizophrenia spectrum disorder)
- F31 (bipolar affective disorder)
- F32 (major depressive disorder)
- Under treatment with a fixed daily dose of antipsychotic medication (>1 month)
- Able to sign informed consent
Exclusion Criteria
- Acute increased risk of suicide
- Unstable mental illness
- Clinical or laboratory evidence of untreated medical disease
Perspective
Validation of a simple fitness test will make it possible to identify and monitor patients with poor fitness and an increased risk of developing cardiovascular diseases. This project and its clinical implementation will not only evaluate whether low fitness can be an explanatory factor for the increased risk of cardiovascular diseases in patients with severe mental illness but also potentially promote the preservation of physical health and prevent early death in these patients.
Contact
Victor Sørensen
PhD student, MSc in human physiology
Email: victor.soerensen@regionh.dk
Financial Matters
Heart in Mind is financially supported by:
- Simon Fougner Hartmann's Family Foundation with 556,065 DKK (journal number: 2023-0065) for the purchase of oxygen uptake equipment and physical activity sensors (funding obtained by Victor Sørensen).
Anchoring
The study takes place at the Psychiatric Center Glostrup and is conducted in collaboration between Centre for Applied Research in Mental Health Care (CARMEN) and the Center for Neuropsychiatric Schizophrenia Research (CNSR).
The study is a PhD project conducted 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) and Professor and psychiatrist Margaret Hahn (Complex Care and Recovery, Schizophrenia Division, Center for Addiction and Mental Health, Toronto, Canada).