A transdiagnostic group exercise intervention for mental health outpatients in Germany (ImPuls): results of a pragmatic, multisite, block-randomised, phase 3 controlled trial.

Autor:	Wolf S; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany. Electronic address: sebastian.wolf@uni-tuebingen.de., Seiffer B; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Zeibig JM; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Frei AK; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Studnitz T; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Welkerling J; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Meinzinger E; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Bauer LL; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Baur J; Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany., Rosenstiel S; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Fiedler DV; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Helmhold F; Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany., Ray A; Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany., Herzog E; Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany., Takano K; Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan., Nakagawa T; Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany., Günak MM; Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany., Kropp S; Chair of Health Economics, Technical University Munich, Munich, Germany., Peters S; German Association for Health-Enhancing Physical Activity and Exercise Therapy, Hürth-Efferen, Germany; Department of Human Sciences, Institute of Sport Science, Bundeswehr University Munich, Munich, Germany., Flagmeier AL; AOK Baden-Württemberg, Stuttgart, Germany., Zwanzleitner L; Techniker Krankenkasse, Hamburg, Germany., Sundmacher L; Chair of Health Economics, Technical University Munich, Munich, Germany., Ramos-Murguialday A; Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Tecnalia, Basque Research and Technology Alliance, San Sebastián, Spain; Athenea Neuroclinics, San Sebastián, Spain., Hautzinger M; Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany., Sudeck G; Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany., Ehring T; Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; German Center for Mental Health, Munich, Germany.
Jazyk:	angličtina
Zdroj:	The lancet. Psychiatry [Lancet Psychiatry] 2024 Jun; Vol. 11 (6), pp. 417-430. Date of Electronic Publication: 2024 Apr 23.
DOI:	10.1016/S2215-0366(24)00069-5
Abstrakt:	Background: Globally, mental health conditions pose a substantial burden of disease. Despite the availability of evidence-based pharmacological and psychological treatments, the symptoms of a substantial subgroup of patients do not respond to these interventions, and only a minority of patients have access to them. This study aimed to assess the efficacy of ImPuls, a 6-month transdiagnostic group exercise intervention, plus treatment-as-usual, compared with treatment-as-usual alone in outpatients with various mental disorders. Methods: In this pragmatic, two-arm, multisite, randomised controlled trial in Germany, ten outpatient rehabilitative and medical care facilities were involved as study sites. Participants were outpatients diagnosed according to ICD-10 with one or more of the following disorders based on structured clinical interviews: moderate or severe depression, primary insomnia, post-traumatic stress disorder (PTSD), panic disorder, or agoraphobia. Participants were required to be aged between 18 years and 65 years, insured by the health insurers Allgemeine Ortskrankenkasse Baden-Württemberg or Techniker Krankenkasse, fluent in German, and without medical contraindications for exercise. Blocks of six participants were randomly allocated to ImPuls plus treatment-as-usual or treatment-as-usual alone (allocation ratio: 1:1), stratified by study site. The randomisation sequence was generated by an external data manager. The team responsible for data collection and management was masked to the randomisation sequence. The ImPuls intervention comprised evidence-based outdoor exercises lasting 30 min, and aimed at achieving at least moderate intensity. It also incorporated behavioural change techniques targeting motivational and volitional determinants of exercise behaviour. Treatment-as-usual was representative of typical outpatient health care in Germany, allowing patients access to any standard treatments. The primary outcome was global symptom severity at 6 months after randomisation, measured using self-report on the Brief Symptom Inventory (BSI-18) and analysed in the intention-to-treat sample. No individuals with lived experience of mental illness were involved in conducting the study or writing the final publication. Safety was assessed in all participants. The trial was registered with the German Clinical Trials Register (DRKS00024152) with a completion date of June 30, 2024. Findings: 600 patients provided informed consent, were recruited to the study, and underwent a diagnostic interview between Jan 1, 2021, and May 31, 2022. Following this, 199 were excluded on the basis of inclusion and exclusion criteria and one withdrew consent during the baseline assessment. Of the 400 eligible participants, 284 (71%) self-identified as female, 106 (27%) self-identified as male, and nine (2%) self-identified as other. The mean age was 42·20 years (SD 13·23; range 19-65). Ethnicity data were not assessed. 287 (72%) participants met the criteria for moderate or severe depression, 81 (20%) for primary insomnia, 37 (9%) for agoraphobia, 46 (12%) for panic disorder, and 72 (18%) for PTSD. 199 participants were allocated to the intervention group of ImPuls plus treatment-as-usual and 201 to the control group of treatment-as-usual alone. 38 (19%) participants did not receive the minimum ImPuls intervention dose. ImPuls plus treatment-as-usual demonstrated superior efficacy to treatment-as-usual alone in reducing global symptom severity, with an adjusted difference on BSI-18 of 4·11 (95% CI 1·74-6·48; d=0·35 [95% CI 0·14-0·56]; p=0·0007) at 6 months. There were no significant differences in the total number of adverse events or serious adverse events between the two groups. There was one serious adverse event (male, torn ligament) related to the intervention. Interpretation: ImPuls is an efficacious transdiagnostic adjunctive treatment in outpatient mental health care. Our findings suggest that exercise therapy should be implemented in outpatient mental health care as an adjunctive transdiagnostic treatment for mental disorders such as depression, insomnia, panic disorder, agoraphobia, and PTSD. Transdiagnostic group exercise interventions might ameliorate the existing disparity in care provision between the many individuals in need of evidence-based treatment and the few who are receiving it. Funding: The German Innovation Fund of the Federal Joint Committee of Germany. Competing Interests: Declaration of interests SP declares that the German Association for Health-Enhancing Physical Activity and Exercise Therapy maintains a training programme for psychiatry, psychosomatics, and addiction. All other authors declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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