Nos ordonnances : pour les patients éduqués, jeunes, et si possible patientes ?

Abstract

Il n’est aujourd’hui plus à démontrer que l’activité et l’exercice physique ont des effets positifs sur l’humeur et l’anxiété. Les études expérimentales décrivent des effets anxiolytiques et antidépressifs tant sur les sujets sains que sur les patients. L’objectif de cet article est de montrer que l’exercice physique au sein d’un service de psychiatrie contribue à l’amélioration de la santé mentale des patients hospitalisés.Les informations sociodémographiques, le diagnostic et l’activité physique (durée, distance, type et fréquence) de 283 patients hospitalisés au sein d’un service de psychiatrie ont été répertoriés. Les membres de l’équipe soignante (20 personnes) ont évalué les patients sur une échelle visuelle analogique de 1 à 10 en fonction de l’amélioration de leur santé mentale. Aucune manipulation expérimentale n’a été effectuée.Cent vingt-huit hommes et 155 femmes présentent les troubles suivants : trouble dépressif majeur, troubles anxieux, dépendance alcoolique, toxicomanie, décompensation psychotique et trouble bipolaire.Les corrélations entre l’amélioration de la santé mentale et la participation aux exercices physiques sont toutes significatives (fréquence : r = 0,228 ; p < 0,001 ; durée : r = 0,236 ; p < 0,001 ; distance : r = 0,201, p = 0,001). Comparativement aux autres groupes, les personnes souffrant d’un trouble dépressif majeur retirent plus d’avantages à la pratique d’un exercice physique (fréquence : p = 0,048 ; durée : p = 0,037 ; distance : p = 0,038). Enfin, le vélo (fréquence : p = 0,008 ; distance : p = 0,016 ; durée : p = 0,011 ;) et la gymnastique (forte) (fréquence : p = 0,016 ; durée : p = 0,018) sont les exercices physiques qui permettent d’optimaliser les résultats obtenus.Pratiquer de l’exercice physique durant une hospitalisation dans un service de psychiatrie influe positivement sur la symptomatologie et contribue à l’amélioration de la santé mentale.There is a general belief that physical activity and exercise have positive effects on mood and anxiety. Intervention studies describe an anxiolytic and antidepressive effect of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological inconsistencies. Our review of the literature showed the importance of distinguishing three items in studies regarding efficacy of physical exercise in psychiatry: operationalisation of concepts (duration, frequency, intensity, type of exercise), the type of disorder, the diagnosis, and exploratory hypotheses. The aim of this article is to demonstrate that physical exercise in the psychiatry department contributes to the improvement of the mental health of in-hospital patients.Sociodemographical data, the diagnosis and the physical exercise (duration, distance, type and frequency) of 283 in-hospital patients in the psychiatry department were listed. Physical exercise (cycling, long walks, short walks, soft and hard gymnastics) included in a database has been proposed to patients for many years in this hospital. After their hospitalisation, the members of the medical staff (20 persons) evaluated the patients on a visual analogic scale from 1 to 10 related to the improvement of their mental health. No experimental manipulation was made.One hundred and twenty-eight men, mean age: 45.67 years (±13.59) exhibited the following disorders: major depressive disorder (117), anxious disorders (25), alcoholic addiction (85), toxicomania (10), psychotic decompensation (33), bipolar disorder (3) and others (10). Patients practised at least one exercise during their hospitalisation, mean duration of 15.93 (±9.18) working days. The frequency of physical exercises per patient was 5.65 (±6.20). The improvement of each patient was evaluated around six times (6.16 ± 3.83). The average amelioration score for all the patients was close to 50% (4.99 ± 1.65).Correlations between the improvement of mental health and participation in physical exercises were all significant (frequency: r = 0.228; P < 0.001; duration: r = 0.236; P < 0.001; distance: r = 0.201, P = 0.001). In comparison with psychotic patients, drug addiction and alcoholic, depressive patients showed greater interest in physical exercise. This is similar for anxious disorders. According to the results, two groups were created regarding their improvement (cut out point: 5.08). We observed that patients suffering from major depression considerably improved thanks to physical exercise (P = 0.048), spent more time practising (P = 0.037) and walked or cycled greater distances (P = 0.038). Finally, cycling (frequency: P = 0.008; distance: P = 0.016; duration: P = 0.011) and “hard” gymnastics were the physical exercises which optimized the results.Physical exercise is correlated with the improvement of mental health. The practice of physical exercise depends on the mental disorder. People suffering from major depressive disorder benefit more from physical exercise than other groups. Cycling and “hard” gymnastics are both exercises to be proposed in every programme.To practice physical exercise during hospitalisation in a psychiatric department has a positive influence on the symptomatology, and contributes to the improvement of mental health.