Suicide is a major public health issue with estimated 1 million deaths worldwide within the last year. Physical activity and nature recreation might be protective factors against suicidal behaviour, suicidal ideation and contributing factors like depression and hopelessness. In this randomized controlled cross-over intervention study the investigators aim to investigate the physical and psychological effects of a 9 weeks hiking program in chronically suicidal patients. The investigators aim to enroll 24 patients suffering from chronic suicidality, defined as at least one attempted suicide and a hopelessness greater than 26 in Beck's Hopelessness Scale summary score. At baseline patients will undergo pre-tests including questionnaires to assess suicide ideation, hopelessness, depression, anxiety, quality of life and health-related physical activity, physiological investigations to assess exercise capacity and blood investigations. Randomly assigned 12 patients start with the 9 weeks supervised mountain hiking program followed by a 9-week-period without supervised exercise program. The other 12 patients start with 9 weeks without supervised exercise program followed by a 9-week-period of supervised mountain hiking program. The mountain hiking program includes 2 training sessions per week with a duration of 3 hours per session. The hiking intervention will be performed within 70-85% of heart rate reserve and gymnastics for body and nature perception, mobilisation and stretching will enrich the training program. Further investigations including questionnaire-assessments, assessment of exercise capacity and blood investigations will be scheduled 9 and 18 weeks after the study start. In addition a daily assessment of several suicide risk-factors based on a web-based questionnaire will be done over the full study period. Within this mountain hiking program the investigators hope to reduce hopelessness in chronically suicidal patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
24
Regularly supervised physical exercise training program. Duration over all: 9 weeks; Frequency: 2 times per week; Duration one training-unit: 3 hours; Program: * Endurance training (performed within 70-85% of the maximum heart rate) * Short exercises before hiking (Mobilisation, Body and nature perception, ca. 5 min) * Stretching after hiking (ca. 5 min) * Short break at half-time (ca. 15 min)
Hopelessness
Summary score BHS (Beck Hopelessness Scale; 20 items)
Time frame: 18 weeks (3 time points)
Exercise capacity
(Watts/kg)
Time frame: 18 weeks (3 time points)
Depression
BDI-2 summary score (Beck depression inventory 2, 21 items)
Time frame: 18 weeks (3 time points)
Anxiety
Summary score BAI (Beck anxiety inventory, 21 items)
Time frame: 18 weeks (3 time points)
Suicide ideation
Summary score BSI (Beck suicide ideation inventory, 21 items)
Time frame: 18 weeks (3 time points)
Quality of life
PLC (Profil der Lebensqualität Chronisch Kranker, 6 subscales: Leistungsvermögen, Genuß- und Entspannungsfähigkeit, Positive Stimmung, Negative Stimmung, Kontaktvermögen, Zugehörigkeitsgefühl)
Time frame: 18 weeks (3 time points)
Blood parameters of inflammation
Interleukin 1 beta, Interleukin 2, Interleukin 6, Interferon gamma, Interleukin 10, Interleukin 17;
Time frame: 18 weeks (3 time points)
suicide risk factors
Several items: * Grundwert aus dem Test zur existentiellen Motivation (Eckhard, 2000, 2 items) * Burdensomeness and Connectedness (Interpersonal needs questionnaire, Joiner 2005, 3 items) * Chronic Suicidality (Paris, 2007, 2 items) * Suicidal Status Form (SSF, Jobes, 2006, 9 items) * Emotionalität und Problembelastung (SNS-subscala, Schiepek, 9 items) * Alcohol consumption (1 item) * Sleep quality (1 item) * Social support (F-SozU-S54, 4 items) * Physical activity (IPAQ-short, 2 items) * Environmental perception (3 items) * Religiousness and spirituality (2 items)
Time frame: 18 weeks (daily)
health-related physical activity
IPAQ short version (International physical activity questionnaire, 2002)
Time frame: 18 weeks (3 time points)
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