A University of Canberra research team is investigating how diet and exercise help young Canberrans with mental illnesses.

With the support of a $200,000 ACT Health Research Innovation Fund grant awarded last year, Associate Professor Andrew McKune and his team have run a 12-week exercise and nutrition intervention for 14- to 24-year-olds who have experienced, or risk developing, early onset psychosis.

“The earlier individualised, structured exercise programs as well as dietary education and intervention are included in the recovery plan of young people who have experienced psychosis, and are on antipsychotics, the better their physical and mental health recovery,” Professor McKune said.

The first 12-week program started in September 2022; the second will begin next month.

“When a young person experiences early onset psychosis and they have had a period of hospitalisation or are not participating in their usual activities due to their illness, they commonly experience challenges integrating back into the community.

“In addition, while antipsychotic medication reduces symptoms of psychosis, it also increases the risk of developing cardiometabolic disease.

“Our program provides a coordinated lifestyle intervention for young people who are at risk of these poorer outcomes. It provides access to accredited dietitians and exercise physiologists who will work with the young person to address dietary and exercise concerns.”

Canberra Health Services refer young people who have experienced psychosis and are on antipsychotic medication, and are cleared to participate, to the lifestyle program.

UC aims to recruit 40 young people; 13 have completed the program so far.

One young man who went through the program last year has started studying psychology at UC, works as a support worker in the community, and will provide peer support with some of the training sessions next month. After being hospitalised for a few weeks last year, he is on antipsychotic medication, but it is gradually being reduced. His fitness levels, lifestyle, and motivation have all improved considerably.

The program has a team of exercise, nutrition, and dietetics researchers, including PhD candidate Tamieka Mawer who works closely with participants to develop healthier eating habits.

Professor McKune joined the program as project lead due to a family member with personal experience.

“I’ve seen firsthand how increasing physical activity levels and healthy eating can help,” he said.

Results will be published in the first half of 2024. Preliminary findings indicate improvements in body composition (decreased body fat and increased muscle), increases in strength and endurance capacity, and improvements in mood and motivation, Professor McKune said.

“Psychosis involves a break from reality that may include paranoia, auditory hallucinations, and manic behaviour,” Professor McKune said.

“Typically, the recovery process includes hospitalisation where antipsychotic medication is started to help reduce the ‘positive’ symptoms of psychosis e.g. such as the auditory hallucinations. Some of the antipsychotic medication as well as the lifestyles of these young individuals increases their risk of developing cardiometabolic disease.

“Life expectancy in the normal population is tracking up over the years. However, the life expectancy of men and women with psychosis is 15 to 20 years lower, and the gap is actually getting worse. People with mental illness have an 80 per cent higher risk of developing cardiovascular disease (CVD), and an 85 per cent higher risk of death from CVD.

“Of course, we know that exercise and diet can improve this; they are the cornerstones of diabetes and CDV treatment and prevention. They are just not being applied in mental health appropriately. In mental health, we now have this overwhelming body of evidence of the benefits of exercise in reducing symptoms of mental illness, and that’s regardless of the diagnosis. A recent paper that summarised 33 systematic reviews and meta-analyses demonstrated the benefits of exercise regardless of diagnosis, depression, anxiety, schizophrenia, substance abuse disorders, and post-traumatic stress disorder.

“Almost more important and exciting is the idea of “prevention’. [That is] where things are heading at the moment. Whilst in the past, the physical health deterioration in people who have experienced psychosis or who have a serious mental illness seemed to just be expected.”

People who start antipsychotic medication gain on average between 7 and 8 kg within three months.

“That is what has been considered normal, what we absolutely expect to happen and is considered best practice care.

“This is neglect, and it is absurd that we accept that patients put on weight.

Research has shown that we prevent the physical health issues, such as excessive weight gain, of people living with mental health issues through early exercise and dietary intervention. In addition, the food that people may be eating at home or in mental health units is not nutrient dense, and there is access to high amounts of refined food and carbohydrates. That has been demonstrated to increase inflammation and metabolic disorders, that in turn further impact mental health.

“We need to start as early as possible monitoring changes in physical health. In general, [when] people with mental illness present at emergency departments or GPs, their metabolic or physical health issues are often ignored in favour of the mental health issues. So people with mental illness are not experiencing the same benefits of improvements such as cardiovascular disease detection and prevention that the rest of the population are.”

However, exercise and nutrition can improve brain health, Professor McKune said. For example, regular endurance (aerobic exercise), performed for 20 to 40 minutes at moderate (60 per cent of heart rate reserve) to vigorous (80 per cent heart rate reserve) intensity two to five days a week increases the blood level of a growth factor called brain-derived neurotrophic factor (BDNF) by around 30 per cent. BDNF plays an important role in brain neuronal survival and growth, serves as a neurotransmitter modulator, and participates in neuronal plasticity, which is essential for learning and memory.

In addition, high carbohydrate / sugar / processed food intake increases inflammation and the risk of metabolic issues, such as insulin resistance, that worsen brain health. Food cravings that include increased sugar / refined carbohydrate intake are a common issue in young people who have experienced psychosis, and are a side effect of some antipsychotic medication.

Combining exercise with dietary education to work on these cravings and increase the intake of appropriate levels of protein and fats and reducing high carbohydrate intake seems to prevent major weight increases and enhances metabolic health.

Professor McKune believes, however, that bodyweight is not the only focus. Like the general population, the number one reason people who experience mental illness start exercising to lose weight.

“However, if we are not addressing their diet and people are on antipsychotic medication, this makes losing weight extremely difficult. We have really got to shift this conversation away from weight loss – even to the point of not measuring weight in the clinics, as this is not a great outcome for long term benefits for people who have experienced psychosis.

“It’s the same story that you might have heard previously. People who are highly motivated, go off and do all this exercise; four to six weeks later, they hop on the scale, and their weight has gone up. How demotivating this is for someone, particularly this population who have experienced psychosis.

“We want to shift the conversation to all the other benefits that we can get from exercise and dietary education. The outcomes that we are focusing on in our study also include overall ‘fitness’, daily ‘functioning’, integration in the community, and behaviour across the day. How does mood change? Are they motivated to get out of bed? Are they engaging better with their friends? Are they sleeping better?

“These are all additional benefits that we are starting to see with our program. Importantly, it has been shown that we can increase the cardiorespiratory (endurance) and muscle (strength) fitness of young people who have experienced psychosis. These increases are positively associated with improvements in mood and motivation.”

ACT health minister Rachel Stephen-Smith said the project was a strong example of the importance of developing the ACT’s health research capability.

“The ACT Government’s Research Innovation Fund, by investing in our people, helps to support valuable research in our community,” Ms Stephen-Smith said.

“This is a key part of Better together: A strategic plan for research in the ACT health system 2022-2030 which helps the ACT’s dedicated health workforce deliver better outcomes for patients.

Applications recently closed for the latest round of the Research Innovation Fund, which offered fellowships of up to $200,000 each.

“I look forward to seeing the successful applicants from this latest round continue to drive collaborative research with our dedicated healthcare workers,” Ms Stephen-Smith said.