Project

ImPuls – a Group Therapeutic Exercise Intervention for the Outpatient Psychotherapeutic Context

Goal: A growing body of research suggests moderate to vigorous physical activity (MVPA) to be ef-fecacious in improving psychopathological symptoms of mental disorders with a high preva-lence, such as major depression, anxiety disorders and insomnia. In spite of its efficacy and applicability, no exercise intervention has yet been developed for the outpatient psychothera-peutic context. To fill this gap, we developed the 12-week exercise intervention “ImPuls”, based on the current evidence about the therapeutic efficacy and (sustainable) promotion of MVPA in outpatients with mental disorders. Between February 2018 and October 2019, the department of Clinical Psychology and Psychotherapy, in cooperation with the Institute of Sports Science (Prof. Dr. Gorden Sudeck) of the University of Tuebingen, evaluated the efficacy (i.e., reduc-tion of psychopathological symptoms, increase of the extent of MVPA) of ImPuls in a random-ized controlled trial. A sample of N = 75 outpatients, suffering from at least one diagnosed men-tal disorder (major depression, anxiety disorders, insomnia), aged between 18 and 65 (M = 35.36, SD = 13.28) and waiting for psychotherapeutic treatment, participated in the study. Using stratified block randomization (stratified variables were age and severity of symptoms), partici-pants were allocated to an intervention group (IG; n = 38) or passive control group (CG; n = 37) when 6 to 10 patients were eligible (IG: n = 3-5; CG: n = 3-5) for study participation. To analyze the change in psychopathological symptoms (Symptom-Checklist-90®-Standard; Pittsburgh Sleep Quality Index, heart rate variability), we included group (IG vs. CG) as a between-subject variable and time (T1: pre); T3: post) as a within subject variable. To analyze the extent of sub-jectively reported MVPA (Physical Activity, Exercise, and Sport Questionnaire, BSA-F) we in-cluded group as a between-subject variable and time (T1; T2: week 9; T3) as a within subject var-iable. Objectively assessed MVPA (accelerometer) was analyzed with group as a between-subject variable at one time point (T2). Linear mixed models will be conducted to determine the change of psychopathological symptoms and extent of MVPA at T3. A linear regression model will be conducted to determine whether the change of symptom reduction was predicted by the increase of MVPA at T2 and T3. Analyses will be conducted using the intention-to-treat-sample.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03542396.

We are currently collecting one-year follow-up data to test the maintenance of effects on psy-chopathological symptoms and the extent of exercise. Furthermore, between June 2020 and June 2023, ImPuls will be implemented and evaluated as an innovative health care project fund-ed by the “Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA)” (see for more in-formation: https://innovationsfonds.g-ba.de/downloads/media/167/Liste-gefoerderte-Projekte-nVF-FBK-19-10-2018.pdf). The aim of the research project will be to evaluate the increase of care efficiency/reduction in waiting time for psychotherapy and the reduction of care costs by the implementation of ImPuls at 10 regional sports and exercise therapy centers in Baden-Württemberg (Germany).

Date: 1 February 2018 - 1 January 2021

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Sebastian Wolf
added a research item
Background Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). Methods This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention “ImPuls”, among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block- randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. Discussion Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. Trial registration The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
Sebastian Wolf
added a research item
Regelmäßige sportliche Aktivität wirkt sich nicht nur auf das körperliche Wohlbefinden aus, sondern hat auch positive Effekte auf die psychische Verfassung. Sport verringert bei Depressionen, Angststörungen, Schlafstörungen und ADHS die Symptomatik deutlich. Trotz dieser klinisch relevanten Effekte gibt es bisher vor allem im ambulanten Versorgungskontext von Patienten mit psychischen Erkrankungen kaum sporttherapeutische Ansätze oder Programme. Das erprobte und evaluierte Programm ImPuls schließt diese Lücke, indem es sport- und bewegungstherapeutische Interventionen für Menschen mit psychischen Erkrankungen anbietet. Im Rahmen des Programms werden die Teilnehmerinnen und Teilnehmer motiviert, sportliche Aktivität zu initiieren und langfristig aufrechtzuerhalten. Der Einbezug des sozialen Umfeldes sowie eine intensive Nachbetreuung unterstützen den Transfer der regelmäßigen sportlichen Aktivität in den Alltag. Umfangreiches Arbeitsmaterial, darunter Handouts, Übungen und ein Trainingsvideo, wird zum Download angeboten.
Sebastian Wolf
added a project goal
A growing body of research suggests moderate to vigorous physical activity (MVPA) to be ef-fecacious in improving psychopathological symptoms of mental disorders with a high preva-lence, such as major depression, anxiety disorders and insomnia. In spite of its efficacy and applicability, no exercise intervention has yet been developed for the outpatient psychothera-peutic context. To fill this gap, we developed the 12-week exercise intervention “ImPuls”, based on the current evidence about the therapeutic efficacy and (sustainable) promotion of MVPA in outpatients with mental disorders. Between February 2018 and October 2019, the department of Clinical Psychology and Psychotherapy, in cooperation with the Institute of Sports Science (Prof. Dr. Gorden Sudeck) of the University of Tuebingen, evaluated the efficacy (i.e., reduc-tion of psychopathological symptoms, increase of the extent of MVPA) of ImPuls in a random-ized controlled trial. A sample of N = 75 outpatients, suffering from at least one diagnosed men-tal disorder (major depression, anxiety disorders, insomnia), aged between 18 and 65 (M = 35.36, SD = 13.28) and waiting for psychotherapeutic treatment, participated in the study. Using stratified block randomization (stratified variables were age and severity of symptoms), partici-pants were allocated to an intervention group (IG; n = 38) or passive control group (CG; n = 37) when 6 to 10 patients were eligible (IG: n = 3-5; CG: n = 3-5) for study participation. To analyze the change in psychopathological symptoms (Symptom-Checklist-90®-Standard; Pittsburgh Sleep Quality Index, heart rate variability), we included group (IG vs. CG) as a between-subject variable and time (T1: pre); T3: post) as a within subject variable. To analyze the extent of sub-jectively reported MVPA (Physical Activity, Exercise, and Sport Questionnaire, BSA-F) we in-cluded group as a between-subject variable and time (T1; T2: week 9; T3) as a within subject var-iable. Objectively assessed MVPA (accelerometer) was analyzed with group as a between-subject variable at one time point (T2). Linear mixed models will be conducted to determine the change of psychopathological symptoms and extent of MVPA at T3. A linear regression model will be conducted to determine whether the change of symptom reduction was predicted by the increase of MVPA at T2 and T3. Analyses will be conducted using the intention-to-treat-sample.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03542396.
We are currently collecting one-year follow-up data to test the maintenance of effects on psy-chopathological symptoms and the extent of exercise. Furthermore, between June 2020 and June 2023, ImPuls will be implemented and evaluated as an innovative health care project fund-ed by the “Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA)” (see for more in-formation: https://innovationsfonds.g-ba.de/downloads/media/167/Liste-gefoerderte-Projekte-nVF-FBK-19-10-2018.pdf). The aim of the research project will be to evaluate the increase of care efficiency/reduction in waiting time for psychotherapy and the reduction of care costs by the implementation of ImPuls at 10 regional sports and exercise therapy centers in Baden-Württemberg (Germany).