Exercise can reduce feelings of hopelessness among patients in suicide crisis, pilot study finds

A new study published in the Journal of Psychiatric Research found preliminary evidence that exercise can alleviate distress among patients in suicide crisis. Inpatients in a psychiatric short stay unit reported reduced feelings of hopelessness after participating in two days of 30 minutes of physical activity.

Psychiatric short stay units (SSUs) provide urgent care to individuals experiencing a mental health crisis. Offered in many developed countries, this brief hospitalization typically covers up to 72 hours of care with the goal of managing the patient’s suicidal behaviors, stabilizing their symptoms, and connecting them to a treatment plan. As psychiatric SSUs have grown in number, studies have emerged examining their safety and efficacy.

Researchers Fabien D. Legrand and his team wanted to test the effects of exercise as an add-on treatment for patients in suicide crisis at an SSU. Numerous studies have suggested that physical activity interventions can improve distress symptoms among individuals with severe mental illness. But few controlled trials have explored the effects of exercise on suicidality, and no trials have been conducted among high-risk patients of an SSU.

“Overall, my area of scientific research is about evaluating the efficacy and safety of physical activity as add-on to drugs and/or psychotherapy in people with mental health issues,” explained Legrand, an assistant professor in psychology at the University of Reims Champagne Ardenne.

“The main reason for the research is that I previously read papers which established the association between physical activity and reduced risk of hopelessness, depression, and suicidal behavior (e.g., Taliaferro et al., 2010). However association between two variables merely implies that knowing the value of one variable provides information about the value of the other. It does not necessarily imply that one causes the other.”

“Establishing that physical activity has causal protective effects against hopelessness requires randomized experiments,” Legrand said. “Our focus of interest was on hopelessness since previous studies have identified it to be the strongest predictor of suicide death (e.g., Ribeiro et al., 2018),”

For their pilot study, Legrand and his colleagues conducted a randomized controlled trial among a sample of patients from a psychiatric SSU in Northeastern France. The patients were 12 women between the ages of 18 and 65 who had recently attempted suicide and had suicidal thoughts or plans.

During an intake visit, participants completed self-report questionnaires measuring hopelessness — a strong predictor of suicide death, and optimism — a protective factor against suicide plans. Subjects were then randomly assigned to partake in two exercise sessions or two sedentary activity sessions over two days, as an add-on treatment to their regular therapy.

Patients in the exercise group participated in two sessions of 30 minutes of brisk walking/jogging in the park of the short-stay unit. Patients in the sedentary group engaged in two 30-minute sessions of alone time in their hospital room, where they participated in sedentary activities like reading or gaming. Following the intervention, participants again completed measures of hopelessness and optimism and then filled out the Subjective Treatment Satisfaction Survey (STSS) to assess the extent that they were satisfied with the intervention and found it to be effective.

The results revealed that patients who participated in the exercise sessions showed significant improvements in hopelessness after the intervention, while those who participated in the sedentary activities did not. Patients in both groups showed relatively stable optimism scores throughout the study.

The findings provide evidence that “adding daily sessions (30 min) of moderate-intensity physical activity (brisk walking/jogging with heart rate maintained at 65%-80% of age-predicted maximal heart rate) to usual care in hospitalized suicidal patients can reduce hopelessness (and hence suicide risk),” Legrand told PsyPost.

Notably, participants appeared to be generally satisfied with the program. Ratings for overall treatment satisfaction were high, and there were no reports of serious adverse events. The program also appeared to be feasible, with an eligibility rate of 74.5%, a retention rate of 75%, and an adherence rate of 80%.

“Perhaps our biggest surprise was the extent to which patients were enthusiastic about their daily exercise routine,” Legrand said.

The authors discuss several reasons why the exercise sessions may have reduced patients’ hopelessness. First, the exercise intervention may have facilitated feelings of competence and autonomy, which may have helped improve patients’ symptoms. Alternatively, the exercise may have served as endurance training, which has been found to inspire physiological changes that can enhance the effects of medical treatments. Another possibility is that the exercise sessions reduced fatigue and low energy, common symptoms of psychiatric sedatives.

Legrand and his colleagues note that their study did not control for several confounds which may have affected the results. For example, patients who partook in the exercise sessions spent time outside the unit and in a park setting. The presence of nature has been found to offer psychological benefits, which may have played a role in the improved symptoms among the exercise group. The researchers also stress that their results are only preliminary, and further studies will be needed to confirm their findings using a well-powered sample.

“This study should be considered as a pilot randomized experiment; it is necessary to replicate our study findings before any firm conclusion can be drawn,” Legrand said.

The study, “Physical activity can reduce hopelessness among women admitted to psychiatric short stay unit following a suicide crisis”, was authored by Fabien D. Legrand, Dany Lallement, and Souhela Kasmi.