Abstract
Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Investigators from 43 centres in 23 countries collected reliability and validity data on the SIMPAQ from patients with DSM or ICD mental illness diagnoses. Test-retest repeatability was assessed one-week apart. Criterion SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Findings: Data were obtained from 1,010 participants. The SIMPAQ had good test-retest reliability (Spearman rho approximately 0.70). Criterion validity for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Criterion validity of the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had greater criterion validity. This alternative method is recommended for use in future studies employing the SIMPAQ. Interpretation: The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals. Funding Statement: SR is funded by an NHMRC Early Career Fellowship (APP1123336). BS is supported by Health Education England and the National Institute for Health Research HEE/ NIHR ICA Programme Clinical Lectureship (ICA-CL-2017-03-001). FG and BS are part supported by the Maudsley Charity and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) at King’s College Hospital NHS Foundation Trust with support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. JBA was supported by the Spanish Ministry of Education (FPU13/05130). Declaration of Interests: We confirm that authors have no competing interests. Ethics Approval Statement: Approval was obtained from the Human Research Ethics Committee (HREC) of UNSW Sydney, Australia (HC15586) as the lead site. Details of individual site ethics approvals from participating sites are listed in Supplementary material.
Highlights
Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness
In order to ensure the accurate assessment of physical activity across people with mental illness, we developed a self-report, physical activity measurement tool, designed to be administered via interview
In a large diverse sample of psychiatric patients, ascertained across a variety of treatment settings and including a range of psychiatric diagnoses, with substantial representation from low- and middle- income countries, we found that the Simple Physical Activity Questionnaire (SIMPAQ) was a reliable tool for assessing physical activity and sedentary behaviour
Summary
Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. People with mental disorders experience high rates of comorbid chronic physical diseases including diabetes, obesity, and cardiovascular disease, contributing to an increased mortality risk, regardless of psychiatric diagnosis [1, 2]. A 2019 Lancet Psychiatry Commission on protecting the physical health of people with mental illness recommended that physical activity be incorporated as part of routine psychiatric care regardless of diagnosis and across all treatment settings [7]. In addition to the established physical health benefits, physical activity can have both preventive and treatment effects on psychiatric symptomatology for people experiencing a range of mental disorders, including depression [8,9,10], anxiety disorders [11] and psychosis [12]. Despite numerous calls for physical activity to be recognised as an integral component of routine psychiatric care [16], including recognition in the recent WHO guidelines [17], access to programs and integration within mental health services remains ad-hoc in many jurisdictions, with limited funding or resources available for implementation in routine clinical care [18]
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