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Aim The aims of this study were to examine if people with first‐episode psychosis (FEP) are able to continue adhering to exercise after a supervised intervention and to explore if the benefits of exercise can be sustained. Methods Twenty‐eight persons with FEP took part in a 10‐week exercise intervention that provided each participant with twice‐weekly accompaniment to exercise activities of their own choice, of whom 20 were re‐assessed 6 months after the intervention. Long‐term adherence to exercise was assessed, and measures of psychiatric symptoms, physical health, neurocognition and social functioning were administered at baseline, post‐intervention and 6‐month follow‐up. Results During the supervised intervention, participants achieved 124.4 min of moderate‐to‐vigorous exercise per week. After 6 months, physical activity levels had decreased significantly (P = 0.025) and only 55% of participants had continued to exercise weekly. Repeated‐measures analysis of variance found that the significant improvements in psychiatric symptoms and social functioning observed immediately after the intervention were maintained at 6 months (P = 0.001). However, post hoc analyses showed that symptomatic reductions were only maintained for those who continued to exercise, whereas symptom scores increased among those who had ceased exercising. Previously observed improvements in waist circumference and verbal memory were lost by 6 months. Conclusion Long‐term exercise participation is associated with significant benefits for symptoms, cognition and social functioning in FEP. However, adherence to unsupervised exercise is low. Future research should explore the effectiveness of ‘step‐down’ support following supervised interventions, and aim to establish sustainable methods for maintaining regular exercise in order to facilitate functional recovery and maintain physical health.

Objective Diet is increasingly recognized as a potentially modifiable factor influencing the onset and outcomes of psychiatric disorders. Whereas, previous research has shown long-term schizophrenia is associated with various nutritional deficiencies, this meta-analysis aimed to determine the prevalence and extent of nutritional deficits in first-episode psychosis (FEP). Method A search of electronic databases conducted in July 2017 identified 28 eligible studies, examining blood levels of 6 vitamins and 10 minerals across 2612 individuals: 1221 individuals with FEP and 1391 control subjects. Meta-analyses compared nutrient levels in FEP to nonpsychiatric controls. Clinical correlates of nutritional status in patient samples were systematically reviewed. Results Significantly lower blood levels of folate (N = 6, n = 827, g = −0.624, 95% confidence interval [CI] = −1.176 to −0.072, P = .027) and vitamin D (N = 7, n = 906, g = −1.055, 95% CI = −1.99 to −0.119, P = .027) were found in FEP compared to healthy controls. Synthesis of clinical correlates found both folate and vitamin D held significant inverse relationships with psychiatric symptoms in FEP. There was also limited evidence for serum level reductions of vitamin C (N = 2, n = 96, g = −2.207, 95% CI = −3.71 to −0.71, P = .004). No differences were found for other vitamins or minerals. Conclusions Deficits in vitamin D and folate previously observed in long-term schizophrenia appear to exist from illness onset, and are associated with worse symptomology. Further research must examine the direction and nature of these relationships (ie, mediator, moderator, or marker) with clinical status in FEP. Future trials assessing efficacy of nutrient supplementation in FEP samples should consider targeting and stratifying for baseline deficiency.

Aim: To examine if people with first-episode psychosis (FEP) are able to continue adhering to exercise after a supervised intervention, and to explore if the benefits of exercise can be sustained. Methods: Twenty-eight people with FEP took part in a 10-week exercise intervention that provided each participant with twice-weekly accompaniment to exercise activities of their own choice. 20 were re-assessed 6 months after the intervention. Long-term adherence to exercise was assessed, and measures of psychiatric symptoms, physical health, neurocognition and social functioning were administered at baseline, post-intervention and 6-months follow-up.Results: During the supervised intervention, participants achieved 124.4 minutes of moderate-to-vigorous exercise per week. After 6 months, physical activity levels had decreased significantly (p=0.025) and only 55% of participants had continued to exercise weekly. Repeated-Measures ANOVA found that the significant improvements in psychiatric symptoms and social functioning observed immediately after the intervention were maintained at 6-months (p=0.001). However, post-hoc analyses showed that symptomatic reductions were only maintained for those who continued to exercise, whereas symptom scores increased among those who had ceased exercising. Previously-observed improvements in waist circumference and verbal memory were lost by 6 months.Conclusion: Long-term exercise participation is associated with significant benefits for symptoms, cognition and social functioning in FEP. However, adherence to unsupervised exercise is low. Future research should explore the effectiveness of ‘step-down’ support following supervised interventions, and aim to establish sustainable methods for maintaining regular exercise in order to facilitate functional recovery and maintain physical health.

Exercise can improve psychiatric symptoms, neurocognitive functioning and physical health in schizophrenia. However, the effects in early psychosis have not been explored. This study aimed to assess the feasibility of an exercise intervention for early psychosis and to determine if it was associated with changes in physical and mental health. Methods: Thirty-one patients with first-episode psychosis (FEP) were recruited from early intervention services to a 10-week exercise intervention. The intervention group received individualized training programmes, aiming to achieve ≥90 min of moderate-to-vigorous activity each week, using exercise programmes tailored to individual preferences and needs. A comparison FEP sample from the same services (n = 7) received treatment as usual. Results: Rates of consent and retention in the exercise group were 94% and 81%, respectively. Participants achieved an average of 107 min of moderate-to-vigorous exercise per week. Positive and Negative Syndrome Scale total scores reduced by 13.3 points after 10 weeks of exercise, which was significantly greater than the treatment as usual comparison group (P = 0.010). The greatest differences were observed in negative symptoms, which reduced by 33% in the intervention group (P = 0.013). Significant improvements were also observed in psychosocial functioning and verbal short-term memory. Increases in cardiovascular fitness and processing speed were positively associated with the amounts of exercise achieved by participants. Conclusion: Individualized exercise training could provide a feasible treatment option for improving symptomatic, neurocognitive and metabolic outcomes in FEP.

Aim People with schizophrenia have poor physical health and high rates of premature mortality. Risk factors for later cardiovascular disease are present from an early stage, and recording of these factors is recommended in first‐episode services. However, it is unclear whether cardiometabolic risk factors are monitored prior to first‐episode psychosis. Methods A retrospective analysis was conducted on case notes of individuals accepted into a specialized early detection service for young people at ultra‐high risk for psychosis. Notes were assessed to determine whether the following physical health measures were recorded: height, weight, body mass index, blood pressure, blood glucose and lipids, physical activity levels, smoking status, substance use and alcohol intake. Results Forty individuals were deemed at ultra‐high risk for psychosis and accepted into the service. The two measures reported most frequently were whether a person used substances (82.5%) or alcohol (72.5%), but more specific details were not commonly reported. A minority of case files contained information on height (2.5%), weight (7.5%), body mass index (5%), blood glucose (2.5%), smoking status (15%) and physical activity (7.5%). Six case files had no measure of physical health. Conclusions Physical health and unhealthy lifestyle factors were not assessed routinely in the specialized service. Clear monitoring guidelines should be developed to establish routine assessment of common metabolic risk factors present in this population.

© 2016 Firth et al. Background: Previous qualitative studies have found that exercise may facilitate symptomatic and functional recovery in people with long-term schizophrenia. This study examined the perceived effects of exercise as experienced by people in the early stages of psychosis, and explored which aspects of an exercise intervention facilitated or hindered their engagement. Methods: Nineteen semi-structured interviews were conducted with early intervention service users who had participated in a 10-week exercise intervention. Interviews discussed people's incentives and barriers to exercise, short- and long-term effects, and opinions on optimal interventions. A thematic analysis was applied to determine the prevailing themes. Results: The intervention was perceived as beneficial and engaging for participants. The main themes were (a) exercise alleviating psychiatric symptoms, (b) improved self-perceptions following exercise, and (c) factors determining exercise participation, with three respective sub-themes for each. Conclusions: Participants explained how exercise had improved their mental health, improved their confidence and given them a sense of achievement. Autonomy and social support were identified as critical factors for effectively engaging people with first-episode psychosis in moderate-to-vigorous exercise. Implementing such programs in early intervention services may lead to better physical health, symptom management and social functioning among service users. Trial registration: Current Controlled Trials ISRCTN09150095. Registered 10 December 2013.

People with psychotic illnesses, such as schizophrenia, have high rates of unhealthy lifestyle factors, such as smoking and physical inactivity. Young people who seek help for mental health care, particularly those at high risk for psychosis, often also display high rates of these unhealthy behaviours. Although healthy living interventions have been applied to people with established psychosis, no attempt has been made to offer them to young people at risk for developing psychosis, despite potential benefits to mental and physical health. We propose that the COM-B model (consisting of capability, opportunity and motivation) and behaviour-change wheel might be an appropriate framework that mental health nurses and other health professionals could apply. Using a systematic and theoretically-based approach to intervention development could result in effective methods of health promotion in this group. Further training and development for mental health nurses could encourage a greater integration of mental and physical health care.

Gym Training Guide used for IBEEP. (PDF 355 kb)