EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence

Isabel Maurus¹, Sarah Wagner¹, Johanna Spaeth¹, Anastasia Vogel¹, Susanne Muenz¹, Valentina Seitz¹, Peter von Philipsborn^{2

3}, Marco Solmi^{4

5

6

7}, Joseph Firth⁸, Brendon Stubbs⁹, Davy Vancampfort¹⁰, Mats Hallgren^{11

12}, Tamás Kurimay¹³, Markus Gerber¹⁴, Christoph U Correll^{7

15

16

17}, Wolfgang Gaebel^{18

19}, Hans-Jürgen Möller¹, Andrea Schmitt^{1

20}, Alkomiet Hasan^{21

22}, Peter Falkai^{1

22

23}

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
² Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany.
³ Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany.
⁴ Department of Psychiatry, University of Ottawa, Ontario, Canada.
⁵ Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada.
⁶ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ontario, Canada.
⁷ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁰ KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
¹¹ Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
¹² Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Australia.
¹³ North-Buda Saint John Central Hospital, Buda Family Centered Mental Health Centre, Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary.
¹⁴ Department of Sport, Exercise and Health (DSBG), University of Basel, Switzerland.
¹⁵ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
¹⁶ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁷ German Center for Mental Health (DZPG), Berlin, Germany.
¹⁸ Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.
¹⁹ WHO Collaborating Centre DEU-131, LVR-Klinikum Düsseldorf, Duesseldorf, Germany.
²⁰ Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil.
²¹ Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany.
²² German Center for Mental Health (DZPG), Munich/Augsburg, Germany.
²³ Max Planck Institute of Psychiatry, Munich, Germany.

PMID: 39655999
PMCID: PMC11733621
DOI: 10.1192/j.eurpsy.2024.1766

EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence

Isabel Maurus et al. Eur Psychiatry. 2024.

. 2024 Dec 10;67(1):e80.

doi: 10.1192/j.eurpsy.2024.1766.

Authors

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
² Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany.
³ Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany.
⁴ Department of Psychiatry, University of Ottawa, Ontario, Canada.
⁵ Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada.
⁶ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ontario, Canada.
⁷ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁰ KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
¹¹ Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
¹² Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Australia.
¹³ North-Buda Saint John Central Hospital, Buda Family Centered Mental Health Centre, Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary.
¹⁴ Department of Sport, Exercise and Health (DSBG), University of Basel, Switzerland.
¹⁵ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
¹⁶ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁷ German Center for Mental Health (DZPG), Berlin, Germany.
¹⁸ Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.
¹⁹ WHO Collaborating Centre DEU-131, LVR-Klinikum Düsseldorf, Duesseldorf, Germany.
²⁰ Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil.
²¹ Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany.
²² German Center for Mental Health (DZPG), Munich/Augsburg, Germany.
²³ Max Planck Institute of Psychiatry, Munich, Germany.

PMID: 39655999
PMCID: PMC11733621
DOI: 10.1192/j.eurpsy.2024.1766

Abstract

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.

Keywords: affective disorder; diet; exercise; schizophrenia; sleep.

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Conflict of interest statement

MS received honoraria/has been a consultant for Angelini, Lundbeck. JF is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1) and has received honoraria/consultancy fees from Atheneum, ParachuteBH, Richmond Foundation and Nirakara, independent of this work. CC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. AS was an honorary speaker for TAD Pharma and Roche and a member of Roche advisory boards. AH was member of advisory boards of Boehringer-Ingelheim, Lundbeck, Janssen, Otsuka, Rovi and Recordati and received paid speakership by these companies as well as by AbbVie and Advanz. He is editor of the German schizophrenia guideline. PF has been EPA president in 2022 and is a co-editor of the German (DGPPN) schizophrenia treatment guidelines and a co-author of the WFSBP schizophrenia treatment guidelines; he is on the advisory boards and receives speaker fees from Janssen, Lundbeck, Otsuka, Servier and Richter. IM, SW, JS, AV, SM, VS, PvP, BS, DV, TK, MH, MG, WG and HJM report no conflicts of interest.

Figures

**Figure 1.**
PRISMA flowchart (from Page et al. [40]).

See this image and copyright information in PMC

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EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence

Affiliations

EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Full Text Sources

Medical

Research Materials