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High-frequency cannabis use in adolescents has been associated with adult mental illness. In contrast, physical activity has been demonstrated to benefit mental health status. The purpose of this study was to examine whether, within a 1-year prospective study design, changes in cannabis use frequency are associated with changes in mental health, and whether meeting physical activity guidelines moderates these associations. COMPASS (2012–2021) is a hierarchical longitudinal health data survey from a rolling cohort of secondary school students across Canada; student-level mental health data linked from Years 5 (2016/17) and 6 (2017/18) were analysed (n = 3173, 12 schools). Multilevel conditional change regression models were used to assess associations between mental health scores change, cannabis use change and physical activity guideline adherence change after adjusting for covariates. Adopting at least weekly cannabis use was associated with increases in depressive and anxiety symptoms and decreases in psychosocial well-being. Maintaining physical activity guidelines across both years improved psychosocial well-being regardless of cannabis use frequency, and offset increases in depressive symptoms among individuals who adopted high frequency cannabis use. Physical activity adherence had no apparent relationship with anxiety symptoms. Regardless of the sequence of events, adopting high frequency cannabis use may be a useful behavioural marker of current or future emotional distress, and the need for interventions to address mental health. Physical activity adherence may be one approach to minimizing potential changes in mental health associated with increasing cannabis use.

Background Physical activity (PA) may predict or mark successful treatment from major depressive disorder after repeated-transcranial magnetic stimulation (r-TMS). Objectives To explore if r-TMS treatment responders were more physically active than non-responders at baseline, and to determine if treatment responders increased PA compared to non-responders post-treatment. Methods Thirty subjects were included in the study. PA was measured through Actical accelerometers. Baseline PA levels were compared through separate independent t-tests, whereas post-treatment changes were compared through separate ANCOVAs. Results There were no differences in PA at baseline between groups. Controlling for baseline PA levels, ANCOVAs identified a non-significant treatment effect between moderate-to-vigorous physical activity levels post-treatment between groups [p = 0.276, η2 = 0.044]. A significant treatment effect was found between groups for light physical activity favouring responders [p = 0.009, η2 = 0.226]. Conclusion Responders’ LPA significantly increased in comparison to non-responders receiving r-TMS for major depressive disorder.

Background: Emerging evidence suggests perceptions of being overweight account for many of the psychosocial consequences commonly associated with obesity, yet limited research has explored weight perception in associations between body mass index (BMI) and academic performance. The current study examined how BMI classification and weight perception relate to academic performance in a large cohort of youth.Methods: We used cross-sectional survey data from 61,866 grade 9-12 students attending the 122 Canadian schools that participated in Year 6 (2017/2018) of the COMPASS study. Mixed effect regression models were used to examine associations between students’ BMI classification and weight perceptions and their math and English/French course grades, stratified by sex.Results: For English/French grades, males and females with overweight or underweight perceptions were less likely to achieve higher grades than their peers with perceptions of being at “about the right weight”, controlling for BMI and covariates. For math grades, females with overweight perceptions, and all students with underweight perceptions, were less likely to achieve higher grades than their peers with “about the right weight” perceptions. All students with BMIs in the obesity range were less likely to report grades of 60% or higher than their peers with “normal-weight” BMIs. Overweight BMIs were predictive of lower achievement in females for English/French grades, and in males for math grades, relative to “normal-weight” BMIs. Results for students that did not respond to weight and weight perception items resembled those for obesity BMI and overweight/underweight perceptions, respectively.Conclusions: Overall, this study demonstrates that an obesity achievement gap remains when controlling for students’ perceptions of their weight, and that both underweight and overweight perceptions predict lower academic performance, regardless of BMI classification. Results suggest barriers to academic success exist among youth with larger body sizes, and those with perceptions of deviating from “about the right weight”.Plain Language Summary: An obesity achievement gap has been suggested as an early contributor to later socioeconomic disparities found by weight status. To date, limited research has examined how sociocultural weight norms contribute to potential links between weight status and academic performance. Emerging evidence suggests weight perception—individual’s subjective appraisal of their body weight—accounts for many of the psychosocial consequences commonly associated with obesity. We sought to determine if body weight and weight perceptions predicted grades in a large sample of Canadian secondary school students. It was hypothesized that perceptions of being at “about the right weight” would provide a protective effect. Overall, this study demonstrates that an obesity achievement gap remains when controlling for students’ perceptions of their weight, and that weight perceptions—both underweight and overweight—predict academic performance, regardless of BMI classification. Results contribute to a body of research that encourages the consideration of both overweight and underweight perceptions and their potential impact on adolescent emotional and physical health. Further research is needed to determine the mechanisms underlying these relationships, in order to remove barriers to academic success among youth with larger body sizes, and those with perceptions of deviating from “about the right weight”.

BackgroundThere remains a need for prospective research examining movement behaviours in the prevention and management of mental illness. This study examined whether changes in adherence to the 24-h Movement Guidelines (moderate-to-vigorous physical activity [MVPA], sleep duration, screen time) were associated with depression symptoms among youth.MethodsConditional change models were used to analyze two waves of longitudinal questionnaire data (2016/17, 2017/18) from students in grades 9–12 (N = 2292) attending 12 schools in Ontario and British Columbia, Canada, as part of the COMPASS study. One-year change in adherence to the MVPA, screen time, and sleep duration guidelines were modeled as predictors of depressive symptoms, adjusting for covariates and prior year depressive symptoms. Models were stratified by sex.ResultsContinued adherence to sleep guidelines and transitioning from inadequate to sufficient sleep were associated with lower depressive symptoms than continued nonadherence, and continued adherence was associated with lower depression than transitioning from sufficient to short sleep. For screen time, transitioning from exceeding guidelines to guideline adherence was associated with lower depressive symptoms than continued nonadherence. MVPA guideline adherence was not associated with depression scores, when controlling for sleep and screen time guideline adherence change and covariates. When combined, meeting additional guidelines than the year prior was associated with lower depressive symptoms among females only.ConclusionsAdherence to the sleep guidelines emerged as the most consistent predictor of depression symptoms. Promoting adherence to the Movement Guidelines, particularly sleep, should be considered priorities for youth mental health at a population level.

Background Exercise is now recommended as a treatment for depression in Canada. What remains less clear is how best to encourage exercise uptake by individuals with mood disorders. The purpose of this scoping review is to identify barriers and facilitators to exercise and physical activity participation among individuals with depression. Method A scoping review with systematic searches was conducted. Eligible studies required samples >50% diagnosed with depression or a mood disorder, and reported empirical data on barriers and/or facilitators to physical activity using quantitative and/or qualitative methods. Extracted barriers and facilitators were classified into the fourteen domains of the Theoretical Domains Framework (TDF). Results Thirteen studies were included (seven quantitative, six qualitative). The most common barriers were classified under the TDF domains of Emotion, Environmental Context & Resources, Beliefs about Capabilities, and Intentions. The most common facilitators were classified under the domains of Beliefs about Consequences, Social Influences, Emotion and Behavioural Regulation. Conclusions Most identified domains are all common determinants of health behaviours in various models and theories applied to physical activity participation. However, the Emotion domain appears to be particularly important to individuals with depression, and yet is not covered by these traditional theories of behaviour change, and may be overlooked when trying to promote physical activity among this population. Future research should investigate the effectiveness of behaviour change interventions that specifically target the Emotion domain, and clearly report the behaviour change techniques employed to do so.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effects of pharmacological interventions for preventing weight gain in people with schizophrenia.

Background Weight gain and obesity are common problems encountered by patients with schizophrenia. This is partially attributable to use of second-generation antipsychotics that are associated with weight gain and other metabolic disturbances. The significance of this prevalence and its impact on premature mortality and morbidity requires better consensus on its management. The objective of this review is to determine the effects of adjunctive pharmacological interventions aimed at reducing weight gain in schizophrenia. Methods We searched the Cochrane Schizophrenia Group’s Trials Register which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Inclusion criteria consisted of all randomized controlled trials examining any adjunctive pharmacological intervention for weight loss in patients with schizophrenia or schizophrenia-like illnesses. The primary outcome of each study had to be body weight or a weight related measure. We reliably selected, quality assessed, and extracted data from studies. As endpoint and change data was combined in the analysis, mean differences (MD) of the change from baseline were calculated using Review Manager 5.3. Results Sixty-one randomized controlled trials met inclusion criteria for this review (pooled n = 3328). Metformin is effective in bringing about modest weight loss (Weight: MD -3.40 kg, 95% CI -4.63 to -2.16; participants = 731; studies = 12; BMI: MD -1.39, 95% CI -1.94 to -0.85; participants = 879; studies = 13). Heterogeneity was reduced by dividing populations into first episode psychosis (FEP) and chronic populations, where FEP patients appeared to benefit most from early metformin intervention (Weight: MD -5.18 kg, 95% CI -6.22 to -4.14; BMI: MD -1.87 kg/m2, 95% CI -2.19 to -1.56; participants = 214; studies = 3) as compared to chronic patients (Weight: MD -2.22 kg, 95% CI -3.07 to -1.37; participants = 517; studies = 9; BMI: MD -1.18 kg/m2, 95% CI -1.89 to -0.48; participants = 665; studies = 10). However, ethnicity could be a confounder for the apparent effect of illness stage, as all first episode metformin intervention studies were conducted in patients with Chinese ethnicity. Metformin as a treatment for weight gain may be associated with additional adaptive changes in fasting insulin levels and insulin resistance. The frequency of adverse effects did not differ between metformin and placebo groups. Moreover, glucagon-like peptide agonists (GLP-1RAs), such as liraglutide and exenatide, were also effective in reducing weight (Weight: MD -3.95 kg, 95% CI -7.08 to -0.83; participants = 165; studies = 3; BMI -1.26 kg/m2, 95% CI -2.21 to -0.30; participants = 165; studies = 3; waist circumference: MD -3.25, 95% CI -5.93 to -0.57; participants = 165, studies = 3). The frequency of adverse effects did not differ between GLP-1RA and placebo groups. Topiramate 200 mg was also effective for weight reduction (Weight: MD=-6.61 kg, 95% CI -9.62 to -3.61; BMI: MD=-2.72, 95% CI -3.25 to -2.20; participants = 181, studies = 3). Discussion This review highlights the promise of pharmacological interventions for decreasing weight gain associated with antipsychotic use. Of the drugs studied, metformin has the most evidence and was most effective in bringing about modest weight loss. Topiramate and GLP-1RA also have accumulating evidence supporting efficacy in reducing weight. Interpretation for other agents is limited by the small number of studies, sample size, and short study duration. Future studies that are adequately powered, with longer treatment duration, will be needed in evaluating the efficacy and safety of interventions for managing weight gain further.

While moderate to vigorous physical activity may be one method of addressing common physical morbidities in schizophrenia, reducing sedentary time may be a low intensity adjunct. In order to determine whether sedentary behaviour is associated with health outcomes, valid and reliable tools for assessing sedentary time are necessary. In order to characterize the validity and reliability of the International Physical Activity Questionnaire (IPAQ) for assessing sitting (sedentary) time, participants completed the IPAQ at baseline and 4 weeks later and wore accelerometers for 7 days before the final assessment. Bland-Altman analyses and intraclass correlation coefficients (ICC) were used to compare agreement between measurements. One-hundred thirteen individuals completed the study. Mean difference between the IPAQ and accelerometer was 26.8 min (95% Limits of Agreement: −458.7–512.3) and ICCA,1 was 0.23 (95% CI: 0.06–0.39). Week 1 and Week 4 administrations of the IPAQ differed by an average of 26.6 min, (95% Limits of Agreement: −510.9–564.2) and ICCA,1 was 0.41 (95% CI: 0.21–0.59). The “minutes” of sitting reported by the IPAQ do not reflect objective sedentary behaviour measurements and this current measure may be unsuitable for the population level assessment of sitting time among individuals with schizophrenia.

Research is needed to develop evidence-based behavioral interventions for preventing and treating obesity that are specific to the schizophrenia population. This study is the precursor to such intervention research where we examined the utility of the social cognitions outlined within the Health Action Process Approach (HAPA) model for predicting moderate to vigorous physical activity (MVPA) intentions and behavior among individuals with schizophrenia or schizoaffective disorder. A prospective cohort design [baseline (T1), week 2 (T2), and week 4 (T3)] was used to examine the HAPA constructs and MVPA across a sample of 101 adults (Mage = 41.5 ± 11.7 years; MBMI = 31.2 ± 7.8 kg/m2; 59% male). Two hierarchical regression analyses were conducted controlling for age, gender, BMI, and previous self-reported MVPA. In the first regression, intentions at T1 were regressed onto the T1 motivational HAPA constructs (risk perception, affective attitudes, task self-efficacy) and social support; MVPA status (meeting vs. not meeting the MVPA guidelines) assessed via accelerometry at T3 was regressed onto T1 social support and intentions followed by T2 action and coping planning, and maintenance self-efficacy in the second analysis. Overall, the motivational and social support variables accounted for 28% of the variance in intentions, with affective attitudes (β = 0.33, p

This chapter will focus on behavioural interventions for patients with schizophrenia and obesity. Building on previous chapters focused on assessment of obesity, this chapter will use a case vignette to apply an approach to assessing and treating obesity in patients with schizophrenia. We will summarize the evidence for behavioural interventions for weight management among patients with schizophrenia and specific components of behavioural approaches will be discussed.

Individuals with schizophrenia tend to have low levels of physical activity (PA) which contributes to high rates of physical comorbidities. Valid and reliable methods of assessing PA are essential for advancing health research. Ten years after initial validation of the Short-Form International Physical Activity Questionnaire (IPAQ), this study expands on the initial validation study by examining retest reliability over a 4-week period, assessing validity with a larger sample, and comparing validity of the IPAQ to a 24-hour recall alternative.Participants completed the IPAQ at baseline and 4weeks later, along with a 24-hour PA recall at week 4. At week 3 participants wore waist accelerometers for 7days. Spearman's correlation coefficients and Bland-Altman plots were calculated based on weekly minutes of moderate to vigorous PA (MVPA).Test-retest reliability for the self-administered IPAQ was ρ=0.47, p0.001 for MVPA. Correlation between IPAQ assessment and accelerometer-determined MVPA was ρ=0.30, p=0.003. The 24-hour recall correlated significantly with MVPA on the previous day ρ=0.27, p=0.012. A Bland-Altman plot indicated the IPAQ-SF underreported by -119.2min (-72%) on average compared to accelerometry (95% limits of agreement -1017.1 to 778.7min, -292% to 147%).Compared to previous IPAQ validation work in this population, criterion validity was similar, but reliability was lower over a 4-week period. MVPA criterion validity of the 24-hour recall was comparable to the 7-day self-report IPAQ. Findings further support that the IPAQ is a suitable assessment tool for epidemiological studies. Objective measures of physical activity are recommended for intervention assessment.

Background Individuals with a severe mental illness (SMI) are at least two times more likely to suffer from metabolic co-morbidities, leading to excessive and premature deaths. In spite of the many physical and mental health benefits of physical activity (PA), individuals with SMI are less physically active and more sedentary than the general population. One key component towards increasing the acceptability, adoption, and long-term adherence to PA is to understand, tailor and incorporate the PA preferences of individuals. Therefore, the objective of this study was to determine if there are differences in PA preferences among individuals diagnosed with different psychiatric disorders, in particular schizophrenia or bipolar disorder (BD), and to identify PA design features that participants would prefer. Methods Participants with schizophrenia (n = 113) or BD (n = 60) completed a survey assessing their PA preferences. Results There were no statistical between-group differences on any preferred PA program design feature between those diagnosed with schizophrenia or BD. As such, participants with either diagnosis were collapsed into one group in order to report PA preferences. Walking (59.5 %) at moderate intensity (61.3 %) was the most popular activity and participants were receptive to using self-monitoring tools (59.0 %). Participants were also interested in incorporating strength and resistance training (58.5 %) into their PA program and preferred some level of regular contact with a fitness specialist (66.0 %). Conclusions These findings can be used to tailor a physical activity intervention for adults with schizophrenia or BD. Since participants with schizophrenia or BD do not differ in PA program preferences, the preferred features may have broad applicability for individuals with any SMI.

Background: Sedentary behavior has been identified as a risk factor for cardiovascular disease and mortality independent of physical activity; the purpose of this study was to profile sedentary behavior in a sample of people with schizophrenia and identify relationships between patterns of sedentary behavior and measures of adiposity.

In addition to offering many physical health benefits, exercise may help improve mental health among individuals with schizophrenia through regulating affect. Therefore, the purpose of this study is to characterize affective responses experienced before, during and after a 10-min bout of exercise versus passive sitting among individuals with schizophrenia. A randomized crossover design compared affect related to feelings of pleasure and arousal at baseline, 6-min into the task, immediately post-task, and 10min post-task to sitting. Thirty participants enroled in the study; 28 participants completed the study. Separate mixed model analyses of variance were conducted for pleasure and arousal, with test order as the between-subject factor, and time and task as within-subject factors. For pleasure, a significant main effect for time and a time x task interaction effect emerged. Post-hoc Bonferroni corrected t-tests (α=.0125) revealed significant differences between pleasure at baseline and both immediately post-task and 10min post-task. No other main effects or interactions emerged. Individuals with schizophrenia derive acute feelings of pleasure from exercise. Thus, exercise may provide a method of regulating affect to improve mental health. Future studies should examine the links between affective responses to health behaviours such as long-term adherence to exercise within this population.