Physical activity interventions have limited evidence for MH

Abstract

A newly published systematic review has concluded that current research evidence is insufficient for determining whether interventions aimed at increasing physical activity represent a cost-effective mental health strategy. Published online May 13 in BMC Public Health, the review encompassed 11 studies that assessed physical activity-oriented interventions for individuals with mental health disorders (including affective and psychotic disorders) and that underwent a full cost-effectiveness evaluation. Studies of interventions that were delivered remotely were excluded from the review. Six of the 11 selected studies examined the benefits of group exercise sessions, such as group walking, dance or circuit training. Most of the studies compared the interventions to usual care. Depression was the most commonly targeted condition in the studies. The effectiveness of the interventions was measured using the quality-adjusted life years (QALYs) instrument. Most of the examined studies were conducted in Europe, with five of them taking place in the United Kingdom. The investigators found that in six of the 11 studies they examined, study authors concluded that the examined interventions were not cost-effective. “These conclusions are primarily driven by uncertainties about the clinical benefit of the interventions,” authors of the review wrote. The remaining five studies concluded that the examined interventions had demonstrated cost-effectiveness. Among the group exercise interventions that were part of this review, circuit training for adolescents with depression and Pilates for patients with schizophrenia were determined not to be cost-effective. “Our review finds that the current evidence is insufficient to come to strong conclusions about whether physical activity-oriented interventions for mental health are cost-effective when compared with the standard of care of other treatment types,” the review's authors wrote. “However, physical activity-oriented interventions that are relatively low cost, such as telephone or web support for exercise goals and motivation, yielded results that were cost-effective.” They added that the QALY measure might not be an ideal indicator when looking at mental health conditions. The authors wrote that “all interventions were delivered for a limited period, and there remains a high uncertainty regarding the real-world, long-term benefits of the programs once sessions are no longer delivered.” The investigators believe that wider use of financial and other incentives in these efforts would improve their cost-effectiveness. A joint program of the World Bank and the Ministry of Finance in Saudi Arabia funded the review.