Javier Bueno-Antequera

Background and Purpose: Individuals with Severe Mental Disorders (SMDs) face a high risk of premature mortality and disability due to accelerated neuromuscular decline. Despite the critical need to monitor physical function, the lack of validated, time‐efficient tools limits their clinical utility and hinders the integration of objective assessments into routine care. This gap limits the early identification of physical function impairments and the implementation of timely evidence‐based interventions. This is the first study to evaluate the criterion validity of the 30‐s Chair Stand Test (30s‐CST) as a pragmatic indicator of lower‐limb muscle strength in adults with SMDs, providing a feasible functional indicator to support routine clinical assessment. Methods: Using a cross‐sectional validation design (STROBE), this study was conducted with 91 adults (18–65 years) diagnosed with SMDs. Participants performed the 30s‐CST and reference isometric Knee Extension Strength (KES) testing. Statistical analyses included Pearson's correlation ( r ), Intraclass Correlation Coefficients ( ICC ), and Bland–Altman plots to determine agreement and heteroscedasticity, with sub‐analyses by sex, age, and body mass index. Results: Analysis revealed significant moderate correlation and agreement ( r = 0.56 [95% CI 0.40–0.69]; ICC = 0.54 [0.38–0.67]; both p < 0.001) for the total sample, with stronger results in the female subgroup. The 30s‐CST demonstrated precision, with a prediction error lower than the within‐subject variability of the reference method. Bland–Altman plots showed acceptable agreement, with narrow limits of agreement (−1.79–1.80), and analysis indicated homoscedasticity. Discussion: The 30s‐CST appears to be a pragmatic and time‐efficient screening tool for identifying individuals with reduced lower‐limb muscle strength in SMDs. Although limited by the lack of biomechanical specificity between dynamic and isometric methods, the test offers a balance between clinical feasibility and its ability to provide a functional estimate related to lower‐limb muscle strength. Integrating this pragmatic screening tool into routine practice may support the assessment of functional performance in resource‐constrained settings where more complex strength assessments are not readily available.

Introduction: Students enrolling in higher education often adopt lifestyles linked to worse mental health, potentially contributing to the peak age onset of mental health problems in early adulthood. However, extensive research is limited by focusing on single lifestyle behaviours, including single time points, within limited cultural contexts, and focusing on a limited set of mental health symptoms. Methods and analysis: The UNIversity students’ LIFEstyle behaviours and Mental health cohort (UNILIFE-M) is a prospective worldwide cohort study aiming to investigate the associations between students’ lifestyle behaviours and mental health symptoms during their college years. The UNILIFE-M will gather self-reported data through an online survey on mental health symptoms (ie, depression, anxiety, mania, sleep problems, substance abuse, inattention/hyperactivity and obsessive/compulsive thoughts/behaviours) and lifestyle behaviours (ie, diet, physical activity, substance use, stress management, social support, restorative sleep, environment and sedentary behaviour) over 3.5 years. Participants of 69 universities from 28 countries (300 per site) will be assessed at university admission in the 2023 and/or the 2024 academic year and followed up for 1, 2 and 3.5 years. Ethics and dissemination: The study was first approved at a national level in Brazil (CAE:63025822.8.1001.5346). Study sites outside Brazil obtained additional ethics approval from their institutions using the main approval. Results from the UNILIFE-M cohort will be disseminated through scientific publications, presentations at scientific meetings, press releases, the general media and social media.

Background : One factor that could reduce the burden associated with severe mental disorders is to improve the detection of people at health risk to prioritize the application of therapeutic interventions. Having specific risk values for robust health variables that can be measured through easy-to-use, inexpensive, feasible and reliable tools would make it possible to overcome the usual lack of resources in mental health services. Aims : To provide reference values for levels of physical fitness (a more powerful predictor of disease, disability and mortality than smoking, hypertension, hypercholesterolaemia and diabetes) evaluated through low-resource tools in people with severe mental disorders. Method : In total, 305 people (83 women) with severe mental disorders aged between 20 and 82 years were evaluated on a set of components of physical fitness (aerobic fitness, strength, flexibility, agility and balance) using the Senior Fitness Test battery. Results : Reference values were provided by quartiles according to sex and age (20–39 years, 40–59 years, > 60 years). Women had significant lower performance than men in the aerobic fitness test (p <0.001; Cohen’s standardized effect size [d]: -0.83, 95 % confidence interval [CI]: -0.54, -1.12) and men had significant lower performance in the lower limb flexibility test (p <0.001; d: -0.55, CI: -0.83, -0.26). Performance in all tests was lower as age increased (standardized regression coefficients [β] ranged from -0.10 to -0.40). Conclusions : This study provides the first reference values for physical fitness components specific to adults with severe mental disorders, helping identify individuals at potential health risk and prioritize therapeutic interventions. The main contribution was to provide the first reference values of a set of physical fitness components specific for adults with severe mental disorders.

Background: In individuals with severe mental illness (SMI), low muscle strength heightens the risk of mortality and chronic disease development. Routine muscle strength assessments could identify vulnerabilities, thereby reducing the growing burden associated with SMI. However, integration into clinical settings faces obstacles because of limited resources and inadequate healthcare staff training. The 5 sit-to-stand (5-STS) test offers an alternative for measuring muscle strength compared with more complex or demanding tests. Nevertheless, its validity in individuals with SMI remains unexplored. Aims: This study aimed to analyse the criterion validity of the 5-STS test in SMI, considering potential age, gender and body mass index influences. Method: In a cross-sectional study following the ‘STrengthening the Reporting of OBservational studies in Epidemiology’ (STROBE) guidelines, 82 adults with SMI (aged 18–65, 24 women) were assessed. Participants underwent both the 5-STS test and the isometric knee extension strength (KES) test. Results: Analysis revealed a significant moderate correlation coefficient and intraclass correlation coefficient (−0.58 for both) for all participants, indicating that the measures are valid and assess related aspects of the same construct. Strong agreement was observed in women and the older age groups. The 5-STS test demonstrated accuracy, with a standard error of estimate lower than the within-subject variability on the KES test. Bland–Altman plots showed limits of agreement values of −3.39 and 3.52 for the entire sample, and heteroscedasticity analyses indicated consistent differences between the 5-STS and KES tests across all groups analysed, except in the women's group. Conclusions: The 5-STS test seems to be a valid test for assessing muscle strength in individuals with SMI, supporting its usefulness for routine assessment in clinical settings, facilitating detection and intervention in critical situations.

Background: Evidence suggests that aerobic training with blood flow restriction is beneficial for treating fibromyalgia. This study evaluated the feasibility, safety, and effects of an aerobic training program with blood flow restriction for women with fibromyalgia. Methods: Thirty-seven women with fibromyalgia were included, and thirteen with an average age of 59 ± 3, a BMI of 26 ± 3, and who were polymedicated started the intervention period. The intervention group performed aerobic exercise with blood flow restriction using occlusive bands placed in the upper part of the rectus femoris, with a total duration of 14 min of restriction divided into two periods of 7 min with a rest period of 3 min and a total session duration of 17 min. Pressure intensity was measured using the visual pain scale (VAS), scoring 7 out of 10 (n = 7). The non-intervention group performed aerobic exercise without restriction of blood flow for the same periods, rest periods, and total duration of the session (n = 6). The intervention included 2 weekly sessions with 72 h between aerobic walking for 9 weeks. Walking was measured individually using the rating of perceived exertion scale (RPE) with an intensity between 6 and 7 out of 10. Visual and verbal support for the VAS and RPE scale was always provided throughout the sessions supervised by the investigator. Functional capacity was assessed using tests (six-minute walk test, incremental shuttle walk test, knee extension and handgrip test by dynamometer, 30 s chair stand test, and timed up-and-go test). Symptomatology was assessed using questionnaires (Widespread Pain Index, Symptom Severity Score, Fibromyalgia Impact Questionnaire, and Multidimensional Fatigue Inventory), and blood samples were collected. Results: There were no adverse effects, and only one participant in the intervention group withdrew. Between-group and intragroup differences showed that the intervention group obtained improvements in the functional tests; CST p = 0.005; 6MWT p = 0.011; Handgrip p = 0.002; TUGT p = 0.002 with reduced impact of the disease according to the questionnaires; FIQ Stiffness p = 0.027 compared with the nonintervention group. Biochemical results remained within normal ranges in both groups. Conclusions: Blood flow-restricted aerobic training may be feasible, safe, and more effective than unrestricted aerobic training as a physical exercise prescription tool to improve cardiorespiratory fitness, strength, balance, and stiffness in women with fibromyalgia.

People with severe mental disorders (SMD) reports low levels of physical activity and high levels of sedentary behaviour in their daily activities. Physical inactivity is the fourth leading cause of global mortality, and it is an independent risk factor for several somatic diseases. Therefore, reducing the growing burden of SMDs is a global health priority. Most mental health services do not consider physical exercise as a key factor in the prevention and treatment of this growing problem. Solving this gap could contribute significantly to reducing patient mortality and comorbidity. For this reason, we need to improve our knowledge of how these interventions can be designed and implemented in the “real world” conditions to improve the uptake and adherence of patients. This chapter explores the implementation gap in mental health services and exposes the barriers, facilitators, and experiences that patients, staff, and trainers reported during the implementation of a physical exercise program. Request access from your librarian to read this chapter's full text.

Severe mental disorders (SMD) are a major contributor to mortality and one of the five leading causes of disability worldwide. Therefore, it is important to establish strategies aimed at improving the physical health in individuals with these disorders, with the aim of reducing the incidence of chronic diseases and promoting health improvement. Cardiorespiratory fitness and muscle strength, which are often impaired in individuals with severe mental disorders, are complementary and independent variables that are related to mortality risk. For this reason, it is necessary to improve the assessment of these parameters to identify vulnerable situations that require early intervention through physical exercise. This chapter examines the importance of physical fitness as a health factor and presents evidence for different physical exercise interventions aimed at improving physical fitness in individuals with SMD. Request access from your librarian to read this chapter's full text.

People with severe mental disorders (SMD) coexist with other diseases derived from a lack of physical activity and sedentary lifestyles. Although physical exercise programs can be interesting when it comes to solving this problem, adherence to them is low and the dropout rate is notable, so that these people do not manage to benefit from the positive effects of physical activity. In this sense, encouraging autonomous motivation seems to be the key to achieving greater attendance at training sessions and achieving a stage of change of action or maintenance. To this end, directing attention toward the support and satisfaction of three basic psychological needs (autonomy, competence, and relationships) seems essential. In this endeavor, different behavior change techniques (BCTs) have been successfully used to promote more self-determined motivations and increase physical activity.