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How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression

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... There is growing evidence that patients with mental illness undergo a decrease in PA [12][13][14][15][16], which is a serious problem because it may be associated with cardiovascular disease, premature mortality, and a decline in physical fitness. ...
... We evaluated the motor functioning and measured the level of PA in elderly patients who had been admitted to psychiatric care wards for long periods of time. In addition, previous studies have often measured the level of PA subjectively, such as by self-reporting by questionnaires; however, compared to objective measurements, this method underestimates sedentary behavior while overestimating MVPA [12][13][14][15][16]. Therefore, we believe that the use of an accelerometer in this study was appropriate and provided an objective measure of PA. ...
... Moreover, the average duration of sedentary behavior in this study was 350 min, which represents more than 70% of the total measuring time. Several meta-analyses on the level of PA in mentally ill patients agree that compared to the general population, mentally ill patients spend significantly more time sedentary [12][13][14][15][16], averaging 660 min per day [14]. This corresponds to 60-70% of awake time, a level comparable to the results of the present study. ...
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The aim of this cross-sectional study was to determine the status of locomotive syndrome (LS) and the level of physical activity (PA) in long-term inpatients in a psychiatric care ward and to investigate the association between the severity of LS and the level of PA. The study participants consisted of 25 patients aged 55 years or older who had been admitted to a psychiatric care ward for more than one year. The participants’ LS stage was determined and their level of PA was measured using an accelerometer. We also analyzed the correlations between the LS stage test results, level of PA, and values for each assessment item. The LS stage test showed that 84.0% of the participants were at stages 3. The participants’ mean step count was 3089.8 ± 2346.5 steps. The participants’ mean sedentary time was 349.7 ± 68.9 min, which is more than 70% of the total measuring time. Overall, the results indicate that LS stage was significantly correlated to age, ADL, and level of PA. Patients who stay in a psychiatric care ward experience declining motor functioning and lack PA. Deterioration of motor functioning is associated with lack of PA, suggesting the need for physical intervention.
... Mental health status is considered as either a barrier or a motivator to participating in physical activities. People with mental illness may encounter difficulties advancing their involvement in PE. [40][41][42]. A study conducted in the USA suggests that poorer mental health, such as COVID-19-related worry and stress, is associated with lower PE [43]. ...
... Perception of unsafe traffic and crime safety may result in more time spent indoors [51]. Although the relationship between the construction of sports facilities and PE participation has received increasing attention, most studies have been conducted in Western or developed countries [32,40]. The situations in developing countries in Asia, especially in China, are still left for empirical discussions. ...
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This study aims to examine the nudging effect of the sports facility construction on physical exercise (PE) participation with consideration of the moderating role of mental health in China. Multiple linear regression models are used in this study. The subjects are 4634 from the 2014 China Family Panel Studies (CFPS) data, which is a nationally representative longitudinal survey of Chinese individuals. We find that the construction of sports facilities nudges people to participate in PE, and gender, age, and education significantly influence people’s participation in PE. Young, female, and better-educated people compose the “neo-vulnerable” population, who participate less in PE in China and need more interventions. Mental health status has no significant effect on people’s PE participation, while it negatively moderates the nudging effect of the construction of sports facilities on PE. The results of this study suggest that only building sporting facilities is insufficient to encourage PE participation. Policies and interventions should be given to mentally disturbed individuals to guarantee and magnify the nudging effect of sports facilities on PE.
... In addition, they undertake less physical activity, especially moderate and vigorous physical activity, and show more sedentary behavior, with more time spent lying down and sleeping each day. 20,28,29 One of the most challenging areas of research with respect to FEP is immune dysfunction, which is largely associated with adipocyte dysfunction. Numerous proteins and cytokines that are secreted by adipose tissue have been shown to play physiological roles in the human body, including in inflammation, coagulation, vascular remodeling, regulation of blood pressure, lipid metabolism, glucose metabolism, energy balance, and appetite. ...
... This is evident in terms of higher prevalences of cigarette smoking and alcohol abuse; poor dietary habits, with the consumption of large amounts of saturated fatty acids, carbohydrates, and salt; and small amounts of fruit and vegetables; and low levels of physical activity. 29,67,68 A recent study showed that the majority of patients with FEP have unhealthy dietary habits, as defined by a lack of consumption of a Mediterranean-style diet, and that this poor diet was associated with a low educational level. 67 However, we did not evaluate or control for the diet or physical activity of the participants in the present study. ...
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Objective: We aimed to assess the prevalence and course of metabolic syndrome (MetS) and the associated metabolic parameters during the year following a first episode pf psychosis (FEP). Methods: We performed a 1-year longitudinal observation of 60 patients who experienced FEP. MetS was defined using the modified definition of the National Cholesterol Education Program Adult Treatment Panel III. We assessed the metabolic parameters and socio-demographic and psychopathological data for the participants. Results: The mean age of the participants was 27.1 years, and 33.3% of them were women. There was an increase in the prevalence of MetS from 6.7% to 11.7% during the year following the baseline assessment during the year following the baseline assessment (p = 0.250). There were also significant increases in the prevalences of abnormal triglyceride concentration, waist circumference, and high-density lipoprotein (HDL)-cholesterol concentration during this period. In addition, there was a considerable worsening of the metabolic profile of the participants. No baseline parameters were identified to be predictors of MetS over the 1-year follow-up period. Conclusions: We can conclude that metabolic abnormalities are common in patients with FEP and that these rapidly worsen during the first year following the diagnosis of FEP. Studies on interventions are needed to reduce metabolic risk to cardiovascular diseases following the FEP.
... During the COVID-19 pandemic, the WHO recommended regularly engaging in exercise to help promote a healthy lifestyle. Despite the known benefits of exercise in patients with schizophrenia in terms of improving cardiometabolic health [48,49], cardiorespiratory function [50], cognitive function [51], and mental health symptoms [48,49,52], under normal conditions this population is usually highly sedentary [53] or tends to engage in less vigorous or moderately vigorous exercise compared to the general population [54,55]. ...
... In our study, in contrast with the results observed in the general population, the participants did not show a decrease in the level of vigorous physical activity [59]. However, as mentioned above, it must be borne in mind that we are referring to a population group that under normal conditions is already very sedentary in itself and practices less physical exercise compared to healthy people [54,55]. ...
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The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population's usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizo-phrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X 2 = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.
... Systematic review evidence has shown that people with SMI are less physically active and spend more time in sedentary behaviour than healthy controls [4][5][6][7][8][9]. They complete less moderate to vigorous physical activity than controls [9], with up to 70% not meeting physical activity guidelines [4,10]. ...
... With 2:1 allocation ratio, two-thirds of participants enrolled will be randomised to the intervention group. Allocations will be undertaken using a permuted block design with unequal block sizes (of 3,6,9). A researcher independent of the study will generate the randomisation sequence and allocate the participant after baseline data collection. ...
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Background People with severe mental illness (SMI) are less physically active and more sedentary than healthy controls, contributing to poorer physical health outcomes in this population. There is a need to understand the feasibility and acceptability, and explore the effective components, of health behaviour change interventions targeting physical activity and sedentary behaviour in this population in rural and semi-rural settings. Methods This 13-week randomised controlled feasibility trial compares the Walking fOR Health (WORtH) multi-component behaviour change intervention, which includes education, goal-setting and self-monitoring, with a one-off education session. It aims to recruit 60 inactive adults with SMI via three community mental health teams in Ireland and Northern Ireland. Primary outcomes are related to feasibility and acceptability, including recruitment, retention and adherence rates, adverse events and qualitative feedback from participants and clinicians. Secondary outcome measures include self-reported and accelerometer-measured physical activity and sedentary behaviour, anthropometry measures, physical function and mental wellbeing. A mixed-methods process evaluation will be undertaken. This study protocol outlines changes to the study in response to the COVID-19 pandemic. Discussion This study will address the challenges and implications of remote delivery of the WORtH intervention due to the COVID-19 pandemic and inform the design of a future definitive randomised controlled trial if it is shown to be feasible. Trial registration The trial was registered on clinicaltrials.gov ( NCT04134871 ) on 22 October 2019.
... Schizophrenia (SZ) is a chronic severe mental illness with an important bearing on the presence of cardiovascular risk (CVR) factors due to an unhealthy lifestyle, including lack of physical activity [1], smoking, substance abuse, and poor diet [2], along with adverse effects of medications [3] and social and economic factors [4]. ...
... However, to the best of our knowledge, no reports are available that have analysed the relationship between the MSWT and VO 2peak in a cohort of adults with SZ. Therefore, the aims of the present study were: (1) ...
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Cardiorespiratory fitness (CRF) can be direct or estimated from different field tests. The Modified Shuttle Walk Test (MSWT) is suitable for all levels of function, allowing a peak response to be elicited. Therefore, we aimed (1) to validate the equation presented in the original study by Singh et al. for evaluating the relationship between MSWT with peak oxygen uptake (VO2peak) in adults with schizophrenia (SZ), (2) to develop a new equation for the MSWT to predict VO2peak, and (3) to validate the new equation. Participants (N = 144, 41.3 ± 10.2 years old) with SZ performed a direct measurement of VO2peak through a cardiopulmonary exercise test and the MSWT. A new equation incorporating resting heart rate, body mass index, and distance from MSWT (R2 = 0.617; adjusted R2 = 0.60; p < 0.001) performs better than the Singh et al. equation (R2 = 0.57; adjusted R2 = 0.57; p < 0.001) to estimate VO2peak for the studied population. The posteriori cross-validation method confirmed the model’s stability (R2 = 0.617 vs. 0.626). The findings of the current study support the validity of the new regression equation incorporating resting heart rate, body mass index, and distance from MSWT to predict VO2peak for assessment of CRF in people with SZ.
... Also, factors such as childhood exposure to air pollution (Antonsen et al., 2020;Schraufnagel et al., 2019a) and deprived socioeconomic circumstances (Rocha et al., 2020;Sariaslan et al., 2016) are associated with both poor respiratory outcomes and schizophrenia. Further, people with schizophrenia typically engage in low levels of physical activity (Stubbs et al., 2016), which is associated with an increased risk of reduced lung function and lung health in the general population (Garcia-Aymerich et al., 2007). Finally, antipsychotic medication may compromise respiratory function through various mechanisms. ...
... We postulate that many factors make people with schizophrenia more vulnerable to respiratory disease. Individually, people with schizophrenia have multiple lifestyle risk factors including increased smoke exposure, both passive and active (Hunter et al., 2020;Lally et al., 2019) and low physical activity (Stubbs et al., 2016). Both the symptoms (e.g. ...
Article
Introduction Despite respiratory disease being a major cause of excess mortality in people with schizophrenia, the prevalence of respiratory conditions in this population is poorly defined. A systematic review and meta-analysis were conducted to establish the prevalence and association of respiratory diseases in people with schizophrenia. Material and methods Major electronic databases were searched from inception to 27 April 2020 for articles reporting respiratory disease (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, and tuberculosis) in people with schizophrenia and, where possible, a control group. A random-effects meta-analysis was conducted. The study was registered with PROSPERO (CRD42018115137). Results Of 1569 citations, 21 studies consisting of 619,214 individuals with schizophrenia and 52,159,551 controls were included in the meta-analysis. Compared to the general population, people with schizophrenia had significantly higher rates of COPD (odds ratio [OR]: 1.82, 95% CI: 1.28–2.57), asthma (OR: 1.70, 95% CI: 1.02–2.83), and pneumonia (OR: 2.62, 95% CI: 1.10–6.23). In people with schizophrenia, the prevalence of COPD was 7.7% (95% CI: 4.0–14.4), asthma 7.5% (95% CI: 4.9–11.3), pneumonia 10.3% (95% CI 5.4–18.6), and tuberculosis 0.3% (95% CI 0.1 –0.8). After adjusting for publication bias, the prevalence of COPD increased to 19.9% (95% CI: 9.6–36.7). Discussion All respiratory diseases examined were significantly more prevalent in people with schizophrenia compared with the general population. Future studies should focus on improving the prevention and management of respiratory disease in this group to reduce associated excess mortality.
... The etiology of CV disease in patients with schizophrenia or psychotic disorder is multifactorial and includes genetical predisposition, lifestyle factors [33][34][35], and risk factors [36], but it is also favored by treatment with certain atypical neuroleptics which may induce weight gain, worsen metabolic conditions [37,38], and be associated with a higher CV risk [39]. As schizophrenia and psychotic disorders are chronic diseases requiring many years of neuroleptic treatment [40,41], a balance between the CV risk and the psychiatric disease stabilization has to be found to assure the well-being and to increase the life expectancy of these patients. ...
... Patients with schizophrenia or psychotic disorder develop severe CV diseases requiring hospitalization at an early age (around ten years earlier than in the general population) and some diseases more frequently than the general population. The high rate and the early occurrence of diabetes mellitus also underlines the risk for CV disease and other complications in a population that is frequently engaged in unhealthy lifestyle [33][34][35]. ...
Article
Objectives We assessed the prevalence of severe cardiovascular (CV) disease requiring hospitalization among patients with schizophrenia in France. Method We included patients hospitalized with schizophrenia or psychotic disorder during 2015, in five French psychiatric hospitals. Patients with CV disease were defined as those with a correspondent ICD-10 code during a hospital stay in any general hospital, five years before or three years after the psychiatric hospitalization. CV disease included myocardial infarction (MI), stroke, heart failure (HF), coronary artery disease (CAD) or peripheral artery disease. Risk factors such as hypertension, obesity and diabetes were recorded. Results In total, 4424 patients with schizophrenia were included. Overall, 203 (4,6%) patients were diagnosed with CV disease, 93 (2.1%) with CAD, 86 (1.9%) with HF and 49 (1.1%) with stroke. The prevalence of hypertension, obesity and diabetes was 11.3%, 9.7% and 7.8%. The median (interquartile range) age of patients with MI and diabetes was 57 (49–70) and 56 (48–66) years. Conclusion Patients with schizophrenia develop severe CV disease requiring hospitalization at an early age. These severe events are associated with a high prevalence of risk factors. Early screening and treatment of CV disease and risk factors is important to improve life expectancy and quality of life of these patients.
... In contrast, physical inactivity associated with sedentary behavior in schizophrenic patients was closely related to a higher prevalence of depressive symptoms (57). Furthermore, due to their negative and depressive symptoms and lack of internal drive, patients with severe mental disorders obtained a lower level of physical activity (58). The relationship between depressive symptoms and physical activity levels is a two-way process (59). ...
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Background Previous evidence suggested that physical activity had beneficial effects on psychopathological symptoms, insomnia, or depressive symptoms in people with schizophrenia. This study investigated the association between physical activity levels and insomnia and depressive symptoms in middle-aged and elderly hospitalized patients with chronic schizophrenia (CS). Methods 179 participants were enrolled. We used the 30-item Positive and Negative Syndrome Scale (PANSS –30 ) to assess the psychopathological symptoms. We used the Insomnia Severity Index scale (ISI) and 17-item Hamilton Depression Scale (HAMD-17) to evaluate insomnia and depressive symptoms. Daily physical activity time less than 30 min, within 30–60 min, and more than 60 min were defined as physical inactivity, moderate physical activity, and vigorous physical activity, respectively. The Chi-square test, analysis of variance (ANOVA), and Mann–Whitney U -test were applied for categorical, continuous, and non-normal distribution variables, respectively. The Pearson or Spearman’s correlation analyses were utilized to examine the association between physical activity levels, ISI total scores, HAMD total scores, and socio-demographic and clinical variables. Finally, socio-demographic variables with a P -value < 0.05 in the comparison between insomnia/depressive group and non-insomnia/depressive group were considered for inclusion in binary logistic regression analysis to determine the relationship between physical activity levels and insomnia or depressive symptoms. Results The ISI total scores ( r = –0.247, P = 0.001) and HAMD total scores ( r = –0.312, P < 0.001) were negatively correlated with physical activity levels. Logistic regression analysis revealed that older age, higher depressive factor scores, and lower physical activity level were influential factors of insomnia symptoms in CS patients ( P < 0.05). In addition, vigorous physical activity (compared with physical inactivity) and higher negative and depressive factor scores were independently associated with depressive symptoms in CS patients ( P < 0.05). Conclusion Physical activity levels were influential factors in comorbid insomnia and depressive symptoms in CS patients. Given the benefits of physical activity, it should be strengthened as a routine adjunct to clinical treatment or psychiatric care so as to improve the physical and mental health of patients with psychiatric symptoms.
... Concomitant diseases caused by cardiometabolic derangement are the biggest contributor to premature death, with an 85% higher risk of death from cardiovascular disease compared to the general population [3]. The reasons for such a disparity in physical health conditions is not fully understood but appear to be multifaceted and are frequently linked to side effects of antipsychotic medication which drive increased appetite, rapid weight gain and metabolic derangement [4], poor diet quality [5], and low physical activity [6]. ...
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The microbiome has been implicated in the development of metabolic conditions which occur at high rates in people with schizophrenia and related psychoses. This exploratory proof-of-concept study aimed to: (i) characterize the gut microbiota in antipsychotic naïve or quasi-naïve people with first-episode psychosis, and people with established schizophrenia receiving clozapine therapy; (ii) test for microbiome changes following a lifestyle intervention which included diet and exercise education and physical activity. Participants were recruited from the Eastern Suburbs Mental Health Service, Sydney, Australia. Anthropometric, lifestyle and gut microbiota data were collected at baseline and following a 12-week lifestyle intervention. Stool samples underwent 16S rRNA sequencing to analyse microbiota diversity and composition. Seventeen people with established schizophrenia and five people with first-episode psychosis were recruited and matched with 22 age-sex, BMI and ethnicity matched controls from a concurrent study for baseline comparisons. There was no difference in α-diversity between groups at baseline, but microbial composition differed by 21 taxa between the established schizophrenia group and controls. In people with established illness pre-post comparison of α-diversity showed significant increases after the 12-week lifestyle intervention. This pilot study adds to the current literature that detail compositional differences in the gut microbiota of people with schizophrenia compared to those without mental illness and suggests that lifestyle interventions may increase gut microbial diversity in patients with established illness. These results show that microbiome studies are feasible in patients with established schizophrenia and larger studies are warranted to validate microbial signatures and understand the relevance of lifestyle change in the development of metabolic conditions in this population.
... According to the findings, ME outperformed the other exercise types for negative symptoms. Given the fact that schizophrenia patients tended to be more sedentary than healthy controls [186], this conclusion may encourage this population to engage in exercise by offering them multiple daily exercise program choices. It was also observed that MBE ranked the second most efficient exercise intervention for treating positive and negative symptoms, with exercise frequency moderating the effects on negative symptoms. ...
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Background The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders. Objective The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders. Methods The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome. Results A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind–body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind–body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms. Conclusion Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).
... Heart, liver and respiratory diseases, diabetes and obesity are three to five times more common amongst people with SMI than in people without SMI (Correll et al., 2017;Liu et al., 2017;Reilly et al., 2015). This is partly attributable to smoking, poor diet (Reilly et al., 2015;The World Health Organization, 2014) and sedentary lifestyles , many individuals with SMI have lower levels of physical activity (PA) (Liu et al., 2017;Reilly et al., 2015;The World Health Organization, 2014;Vancampfort et al., 2016) and increased levels of sedentary behaviour than the general population (Schuch et al., 2017;Stubbs et al., 2016aStubbs et al., , 2016bVancampfort et al., 2017b). Increasing PA and reducing sedentary behaviour, along with other changes to health risk behaviour (e.g., improved diet, cessation of smoking), could reduce the mortality gap people with SMI experience by approximately 28% (Dregan et al., 2020). ...
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Improving health outcomes for people with severe mental illness (SMI) through increased physical activity (PA) on a large scale remains an elusive goal. There is promising evidence that increasing levels of PA in people with SMI can improve psychological and physical health outcomes. However, SMI is associated with reduced levels of physical activity and more sedentary behaviour than is usual in people without SMI. Increasing PA and reducing sedentary behaviour among people with SMI is a complex process, as there are drivers of these behaviours at the individual, household, community and policy levels. Examples of these include the symptoms associated with SMI, poverty, unemployment, social isolation and stigma. Such drivers affect opportunities to take part in PA and individuals’ abilities to do so, creating negative reinforcing loops of behaviours and health outcomes. Most previous approaches to PA for this population have focused largely on individual behaviour change, with limited success. To increase levels of PA effectively for people with SMI at scale also requires consideration of the wider determinants and complex dynamic drivers of PA behaviour in this population. This position paper sets out a rationale and recommendations for the utilisation of whole systems approaches to PA in people with SMI and the improvement of physical and psychological outcomes. Such approaches should be delivered in conjunction with bespoke, individual-level interventions which address the unique needs of those with SMI.
... Additionally, individuals with SMI have other risk factors for obesity: they are more likely to be low-income, experience stressful life events and social isolation (Martin et al., 2016), and to have weight gain from psychiatric medications (Barton et al., 2020). Furthermore, they also engage in less physical activity than the general population (Stubbs et al., 2016). As a result, they are more likely to have cardiovascular disease, and other physical conditions, which contribute to the shorter life expectancy of those with SMI (Janssen et al., 2015). ...
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Rates of food insecurity are high among adults with serious mental illness (SMI); this population also engages in less physical activity than the general population. However, the relationship between food insecurity and physical activity in this group has not been explored. We examined food insecurity prevalence and its association with physical activity in 314 adults with SMI living in supportive housing in New York City and Philadelphia and enrolled in an institutional review board-approved randomized controlled trial of a Peer Group Lifestyle Balance (PGLB) program. We analyzed 2014 baseline survey data, including demographic data and self-reported food security, and four self-reported physical activity outcomes: any physical activity per week (yes/no) and 2) total, 3) moderate, or 4) vigorous physical activity minutes per week. A logistic regression model examined food security as a predictor of any physical activity; zero-inflated negative binomial regression models were used for the other three physical activity outcomes; demographic and clinical predictors were assessed for inclusion in models. Over half of participants (51.7%) reported low or very low levels of food security. Relationships between food insecurity and three physical activity measures (any physical activity, total weekly minutes, and moderate weekly minutes) were non-significant; those with lower food security were more likely to engage in vigorous physical activity. The high food insecurity prevalence highlights the importance of measuring and addressing food security in populations experiencing SMI; measuring physical activity is also important for tailored lifestyle recommendations. Future studies should examine longitudinal changes in food security and physical activity.
... The overall physical activity levels were significantly lower for all patients in our sample compared to healthy controls, as expected, and the mean METs per day were significantly higher in controls than in patients, according to the higher levels of physical activity. The distribution of physical activity intensity among patients with SSDs, regardless of the prescribed antipsychotic therapy regimen, and controls in our sample was in line with previous evidence, which showed a pattern of less moderate physical activity and even less vigorous physical activity compared to healthy controls (Stubbs et al., 2016). Several previous studies have also evaluated physical activity in residential patients and outpatients, reporting low levels of physical activity in both groups and underlining the importance of implementing physical activity in both treatment settings. ...
Article
Antipsychotic polypharmacy (APP) in patients with schizophrenia spectrum disorders (SSDs) is usually not recommended, though it is very common in clinical practice. Both APP and SSDs have been linked to worse health outcomes and decreased levels of physical activity, which in turn is an important risk factor for cardiovascular diseases and premature mortality. This real-world, observational study aimed to investigate antipsychotic prescribing patterns and physical activity in residential patients and outpatients with SSDs. A total of 620 patients and 114 healthy controls were recruited in 37 centers across Italy. Each participant underwent a comprehensive sociodemographic and clinical evaluation. Physical activity was monitored for seven consecutive days through accelerometer-based biosensors. High rates of APP were found in all patients, with residential patients receiving more APP than outpatients, probably because of greater psychopathological severity. Physical activity was lower in patients compared to controls. However, patients on APP showed trends of reduced sedentariness and higher levels of light physical activity than those in monopharmacy. Rehabilitation efforts in psychiatric residential treatment facilities were likely to result in improved physical activity performances in residential patients. Our findings may have important public health implications, as they indicate the importance of reducing APP and encouraging physical activity.
... Previous studies have shown that good social support can increase compliance [31]. Other evidences have demonstrated that the most important treatment approach for controlling schizophrenic symptoms is medication, which can significantly reduce the recurrence and re-hospitalization rates in patients [32,33]. In addition, improvement of living standards and social ability are closely associated with targeted training during rehabilitation, which also represents one of the most important activities of early stage rehabilitation. ...
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Aims Although community psychiatric rehabilitation plays an important role in returning persons with schizophrenia to the society, many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study is aimed to explore the underlying causes of this trend and identify possible solutions. Methods This study used a qualitative descriptive design to examine the persons with schizophrenia who stay in rehabilitation centers for longer periods of time. The researchers conducted semi-structured telephone interviews with the patients recruited through purposeful sampling. The audio-recorded interviews were transcribed in transcripts in Chinese. Thematic analysis was performed using Colaizzi's 7-step method. Results Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society. Conclusions Persons with schizophrenia with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.
... Furthermore, in a previous meta-analysis examining glucose dysregulation in FEP, sensitivity analysis examining studies in which participants were matched for diet and physical activity levels remained significant for raised fasting glucose levels in patients (Pillinger et al., 2017a). However, individuals in the prodromal state already have poorer dietary habits and decreased physical activity compared with age-matched controls, thus we cannot rule out residual confounding in the current meta-analysis (Koivukangas et al., 2010;Stubbs et al., 2016). ...
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Background First-episode psychosis (FEP) is associated with metabolic alterations. However, it is not known if there is heterogeneity in these alterations beyond what might be expected due to normal individual differences, indicative of subgroups of patients at greater vulnerability to metabolic dysregulation. Methods We employed meta-analysis of variance, indexed using the coefficient of variation ratio (CVR), to compare variability of the following metabolic parameters in antipsychotic naïve FEP and controls: fasting glucose, glucose post-oral glucose tolerance test (OGTT), fasting insulin, insulin resistance, haemoglobin A 1c (HbA 1c ), total-cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides. Standardised mean difference in metabolic parameters between groups was also calculated; meta-regression analyses examined physiological/demographic/psychopathological moderators of metabolic change. Results Twenty-eight studies were analysed (1716 patients, 1893 controls). Variability of fasting glucose [CVR = 1.32; 95% confidence interval (CI) 1.12–1.55; p = 0.001], glucose post-OGTT (CVR = 1.43; 95% CI 1.10–1.87; p = 0.008), fasting insulin (CVR = 1.31; 95% CI 1.09–1.58; p = 0.01), insulin resistance (CVR = 1.34; 95% CI 1.12–1.60; p = 0.001), HbA 1c (CVR = 1.18; 95% CI 1.06–1.27; p < 0.0001), total-cholesterol (CVR = 1.15; 95% CI 1.01–1.31; p = 0.03), LDL-cholesterol (CVR = 1.28; 95% CI 1.09–1.50; p = 0.002), and HDL-cholesterol (CVR = 1.15; 95% CI 1.00–1.31; p < 0.05), but not triglycerides, was greater in patients than controls. Mean glucose, glucose post-OGTT, fasting insulin, insulin resistance, and triglycerides were greater in patients; mean total-cholesterol and HDL-cholesterol were reduced in patients. Increased symptom severity and female sex were associated with worse metabolic outcomes. Conclusions Patients with FEP present with greater variability in metabolic parameters relative to controls, consistent with a subgroup of patients with more severe metabolic changes compared to others. Understanding determinants of metabolic variability could help identify patients at-risk of developing metabolic syndrome. Female sex and severe psychopathology are associated with poorer metabolic outcomes, with implications for metabolic monitoring in clinical practice.
... Doctors, rehabilitation staff, other patients and family members represent an important social support system for schizophrenic patients. Previous studies have shown that good social support can increase compliance [31].Other evidences have demonstrated that the most important treatment approach for controlling schizophrenic symptoms is medication, which can signi cantly reduce the recurrence and re-hospitalization rates in patients [32,33]. In addition, improvement of living standards and social ability are closely associated with targeted training during rehabilitation, which also represents one of the most important activities of early stage rehabilitation. ...
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Aims: Although community psychiatric rehabilitation plays an important role in returning schizophrenic patients to the society, Many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study aimed is to explore the underlying causes of this trend and identify possible solutions. Methods: A total of 28 schizophrenic patients were enrolled in this study. We used semi-structured telephone interviews to obtain patients’ perceptions on the effectiveness and attraction of community mental rehabilitation, as well as the difficulties of social inclusion, then applied the grounded theory to analyze the responses. Investigation of interviews include effect of community rehabilitation, attractiveness, and difficulties in social communication. Results: Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society. Conclusions: Schizophrenic patients with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.
... 8,9 People with insomnia who participate in physical activities show significantly reduced insomnia symptoms and lower depressive and anxiety scores compared to those than the general population and only about 25% of them adhere to the recommended 150 min of PA per week. [18][19][20] Costa et al. 21 indicated that sleep quality was positively associated with the duration of moderate and total PA in schizophrenia (including inpatients). ...
Article
Background: People with mental illness often experienced sleep disturbances. Physical activity and psychological factors may be associated with sleep quality among people with mental illness. Aim: The purpose of this study was to assess the association between physical activity (PA), psychological distress, perceived stress, and sleep quality in people with mental illness. Methods: Sixty-seven people with schizophrenia, major depressive disorder, and dysthymia were enrolled in the study group. All participants completed the International PA Questionnaire, Kessler psychological distress Scale, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index (PSQI). Results: The results revealed that moderate metabolic equivalent task (MET)-minutes/week (min/wk) and psychological distress accounted for 39% of the variance in subjective sleep quality. Walking MET-min/wk and psychological distress accounted for 24% of the variance in the use of sleep medication. Vigorous MET-min/wk, psychological distress, and perceived stress accounted for 42% of the variance in daytime dysfunction over the previous month. Psychological distress was a significant related factor for sleep duration (adjusted R[2] = 0.20) and sleep disturbances (adjusted R[2] = 0.33), respectively. A majority of the participants (n = 58, 87%) used sleep medication and most (91%) of them had PSQI ≥5, which was suggestive of sleep problems. Conclusion: Our results indicated that PA, psychological distress, and perceived stress could have impact on different aspects of sleep quality. More research is needed to explore the association between these variables on sleep quality in people with mental illness.
... Since the previous inflammatory subtype findings (Cai et al., 2020;Catts et al., 2014;Fillman et al., 2013Fillman et al., , 2014Fillman et al., , 2016Lizano et al., 2021;Zhang et al., 2016) could have been confounded by illness chronicity, antipsychotic medications, and lifestyle habits (i.e. diet/exercise), (Brown et al., 1999;Dickerson et al., 2007;Ferrante, 2007;Pollmächer et al., 2000;Stubbs et al., 2016), we test the replicability of the inflammatory subtype hypothesis in an antipsychotic-naïve first-episode schizophrenia (FES) population. We hypothesize that elevated inflammatory subtypes exist in the antipsychotic-naïve FES population and that the high inflammatory group would display greater brain thickness and volume measures as well as demonstrate less efficient topological organization compared to the low inflammatory group and HCs. ...
Article
Background Peripheral inflammation is implicated in schizophrenia, however, not all individuals demonstrate inflammatory alterations. Recent studies identified inflammatory subtypes in chronic psychosis with high inflammation having worse cognitive performance and displaying neuroanatomical enlargement compared to low inflammation subtypes. It is unclear if inflammatory subtypes exist earlier in the disease course, thus, we aim to identify inflammatory subtypes in antipsychotic naïve First-Episode Schizophrenia (FES). Methods 12 peripheral inflammatory markers, clinical, cognitive, and neuroanatomical measures were collected from a naturalistic study of antipsychotic-naïve FES patients. A combination of unsupervised principal component analysis and hierarchical clustering was used to categorize inflammatory subtypes from their cytokine data (17 FES High, 30 FES Low, and 33 healthy controls (HCs)). Linear regression analysis was used to assess subtype differences. Neuroanatomical correlations with clinical and cognitive measures were performed using partial Spearman correlations. Graph theoretical analyses were performed to assess global and local network properties across inflammatory subtypes. Results The FES High group made up 36% of the FES group and demonstrated significantly greater levels of IL1β, IL6, IL8, and TNFα compared to FES Low, and higher levels of IL1β and IL8 compared to HCs. FES High had greater right parahippocampal, caudal anterior cingulate, and bank superior sulcus thicknesses compared to FES Low. Compared to HCs, FES Low showed smaller bilateral amygdala volumes and cortical thickness. FES High and FES Low groups demonstrated less efficient topological organization compared to HCs. Individual cytokines and/or inflammatory signatures were positively associated with cognition and symptom measures. Conclusions Inflammatory subtypes are present in antipsychotic-naïve FES and are associated with inflammation-mediated cortical expansion. These findings support our previous findings in chronic psychosis and point towards a connection between inflammation and blood-brain barrier disruption. Thus, identifying inflammatory subtypes may provide a novel therapeutic avenue for biomarker-guided treatment involving anti-inflammatory medications.
... 49 50 Similarly, patients with psychotic diseases, such as Schizophrenia, generally have a very low level of physical activity. 51 Hyperglycaemia and diabetes have been related to worse outcomes after ICH. Diabetes and high blood glucose in nondiabetic patients have been associated with cerebral complications, and are independent predictors of 30-day mortality, and 3-month mortality following ICH. ...
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Introduction Piling evidence suggests that a higher level of prestroke physical activity can decrease stroke severity, and reduce the risk of poststroke mortality. However, prior studies have only included ischaemic stroke cases, or a majority of such. We aim to investigate how premorbid physical activity influences admission stroke severity and poststroke mortality in patients with intracerebral haemorrhage, compared with ischaemic stroke. A prespecified analysis plan counteract some inherent biases in observational studies, and promotes transparency. Methods and analysis This is a statistical analysis protocol for a matched cohort study, including all adult patients with intracerebral haemorrhage, and matched ischaemic stroke controls, treated at Sahlgrenska University Hospital in Sweden between 1 November 2014 and 30 June 2019. All patients have been identified in the Väststroke register, and the data file has been sent for merging with national registries. The follow-up of time for survival will be approximately 2–7 years. The sample size calculation indicates that a minimum of 628 patients with intracerebral haemorrhage is needed for power of 80% at an alpha level of 0.01. Multiple imputation by chained equations will be used to handle missing data. The entire cohort of patients with intracerebral haemorrhage will be matched with consecutive ischaemic stroke controls (1:3 ratio) using nearest neighbour propensity score matching. The association between prestroke physical activity and admission stroke severity will be evaluated using multivariable ordinal regression models, and risk for all-cause mortality will be analysed using multivariable Cox proportional-hazards models. Potential confounders include age, ethnicity, income, educational level, comorbidity, medical treatments, alcohol-related disorders, drug abuse and smoking. Ethics Data collection for the Physical Activity Pre-Stroke In GOThenburg project was approved by the Regional Ethical Board on 4 May 2016. An additional application was approved by the National Ethical Review Authority on 7 July 2021.
... Schizophrenia spectrum disorders are associated with lower life expectancy of 15-20 years, which may be partially accounted for the impact of these disorders on health behaviors (Hjorthoj et al., 2017;Kurdyak et al., 2021;Nielsen et al., 2021). Meta-analyses indicate that subjects with schizophrenia have lower physical activity (PA), particularly of moderate to vigorous activity than healthy controls (moderate activity -10 min per day, vigorous activity -3 min per day) (Stubbs et al., 2016;Vancampfort et al., 2017). Some of the studies on PA in schizophrenia suggested a negative impact of side effects of antipsychotic medication (Vancampfort et al., 2017;Vancampfort et al., 2012), e.g. ...
Article
Individuals with schizophrenia engage in more sedentary behavior than healthy controls, which is thought to contribute to multiple health adversities. Age, medication side effects and environment are critical determinants of physical activity in psychosis. While motor abnormalities are frequently observed in psychosis, their association with low physical activity has received little interest. Here, we aimed to explore the association of actigraphy as an objective measure of physical activity with clinician assessed hypokinetic movement disorders such as parkinsonism and catatonia. Furthermore, we studied whether patients with current catatonia would differ on motor rating scales and actigraphy from patients without catatonia. In 52 patients with schizophrenia spectrum disorders, we cross-sectionally assessed physical activity using wrist actigraphy and ratings of catatonia, parkinsonism, and negative syndrome. The sample was enriched with subjects with severe psychomotor slowing. Lower activity levels correlated with increased age and severity of catatonia and parkinsonism. The 22 patients with catatonia had lower activity as well as higher scores on parkinsonism, involuntary movements, and negative symptoms compared to the 30 patients without catatonia. Collectively, these results suggest that various hypokinetic motor abnormalities are linked to lower physical activity. Therefore, future research should determine the direction of the associations between hypokinetic motor abnormalities and physical activity using longitudinal assessments and interventional trials.
... First, the construct validity and test-retest reliability of the PAVS are still unknown in this vulnerable population. A self-report physical activity questionnaire is less accurate than objective assessments (Soundy et al., 2014;Stubbs et al., 2016), as it may overestimate physical activity levels (Ainsworth et al., 2006). The PAVS method also does not capture light intensity physical activity and sedentary behaviour. ...
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Aim: The aim of the current study was to explore correlations between continuous physical activity (PA) levels and HIV-related stigma and differences in HIV-related stigma between those who meet versus those who do not meet the international PA recommendation of 150 min of PA per week at moderate intensity. Methods: 295 people living with HIV (PLHIV) (median [interquartile range] age = 37.0 [16.0]; 67.8% [n = 200] female) from central Uganda completed the Internalised AIDS-Related Stigma Scale (IA-RSS), Generalised Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Alcohol Use Disorders Identification Test (AUDIT) and the Physical Activity Vital Sign (PAVS). Results: There was a significant correlation between the PAVS and IA-RSS scores correcting for GAD-7, PHQ-9 and AUDIT scores (r = −0.15, p = 0.009). The IA-RSS score was also significantly different between those meeting versus not meeting PA guidelines. Conclusions: Our data demonstrate that higher internalised HIV-related stigma is associated with lower levels of physical activity. The current evidence demonstrates the need to explore whether HIV stigma-reduction interventions could improve physical activity participation and consequently physical and mental health outcomes in PLHIV.
... In accordance with the well-known postulated psychological effects of physical activity, participants in several qualitative studies report a positive impact on mental health, improvements in symptoms of mental health illness and better management of the illness/symptoms through physical activity [23][24][25][26][27][28]. Many of these studies on physical activity and mental health assume a connection between physical and mental health through some physiological and endocrine changes and focus on the impact of physical activity on the symptoms of mental disorders [20,21,[29][30][31]. There has been less focus on the aspect of physical activity as something that can facilitate other processes associated with recovery and a better quality of life and well-being. ...
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Mental health care policies call for health-promoting and recovery-oriented interventions, as well as community-based programs supporting healthier habits. The purpose of this study was to explore how individuals facing mental health challenges experienced participating in tailored exercise at a community-based activity center, and what role tailored exercise could play in supporting an individual's process of recovery. Data were collected through in-depth interviews with nine adults experiencing poor mental health who engaged in exercise at the activity center. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Participants spoke about the community-based program being a safe space where they could "come as they are" (Theme 1). Taking part in the program was "more than just exercise" and allowed them to connect with others (Theme 2). The experiences they gained from exercise also helped with other areas in life and provided them with a safe space to build their confidence towards the "transition back to the outside" (Theme 3). We summarized the findings into one overall theme: "inside vs. outside". In conclusion, a community-based activity center acted as a liminal space that aided mental health recovery by allowing participants to feel safe, accepted and supported, as well as experience citizenship. The findings highlight the need to treat mental health challenges as a contextual phenomenon and creating arenas for community and citizenship in society.
... Although there are clear links between mental disorders and the incidence of metabolic diseases, only several papers existed about the effects of dietary habits on meta-bolic syndrome in patients with schizophrenia. Moreover, previous meta-analyses showed less physical activity, high levels of sedentary behavior and low cardiorespiratory fitness levels in patients with schizophrenia [12][13][14]. To date, it is not established whether, compared to AN-SZ patients, physical activity participation and weight management and nutrition are worse in chronic schizophrenia (C-SZ) patients. ...
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Aim of the study This study aimed to compare the prevalence of MetS and cardiovascular risk factors in antipsychotic naïve schizophrenia (AN-SZ) and chronic schizophrenia (C-SZ) patients. Also, the effects of lifestyle, physical activity and clinical characteristics of these patients on metabolic syndrome were explored. Subject or material and methods In this cross-sectional study, 150 patients, 16-65 aged years were included. All subjects were recruited from the Psychiatric clinic of a tertiary hospital, ---, ---. The severity of symptoms was assessed by the Positive and Negative Syndrome Scale. Physical activity and lifestyle were evaluated by the Baecke and Lifestyle questionnaires. Results Fifty AN-SZ patients and 100 C-SZ patients participated. The rate of abdominal obesity was 29.2% for females and 10.3% for males. The C-SZ patients had significantly fewer healthy habitual physical activity and lifestyle, compared with AN-SZ patients. The prevalence of MetS in the AN-SZ and C-SZ groups was 8% and 23%, respectively (odds ratio [OR] 3.13). Binary logistic regression revealed age and unhealthy lifestyle to be significant predictors of MetS (adjusted OR 1.09 and 0.65, respectively). Discussion We found with increasing each 10 years, the odds of MetS to increase 2.37 times. There was a significant negative association between a healthy lifestyle of SZ patients and MetS. The results showed A decrease in the score of the Lifestyle questionnaire by each one-point to increase the odds of MetS by 45%. Conclusions Future studies are recommended to explore the importance of weight management and nutrition control for reducing the rate of MetS.
... A comparative meta-analysis in schizophrenic patients [17] showed already some interesting differences between levels of moderate and intense PA depending on the setting. A higher level of light physical activity was observed in community and outpatient settings than in inpatient settings. ...
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Physical inactivity is discussed as one of the most detrimental influences for lifestyle-related medical complications such as obesity, heart disease, hypertension, diabetes and premature mortality in in- and outpatients with major depressive disorder (MDD). In contrast, intervention studies indicate that moderate-to-vigorous-intensity physical activity (MVPA) might reduce complications and depression symptoms itself. Self-reported data on depression [Beck-Depression-Inventory-II (BDI-II)], general habitual well-being (FAHW), self-esteem and physical self-perception (FAHW, MSWS) were administrated in a cross-sectional study with 76 in- and outpatients with MDD. MVPA was documented using ActiGraph wGT3X + ® accelerometers and fitness was measured using cardiopulmonary exercise testing (CPET). Subgroups were built according to activity level (low PA defined as MVPA < 30 min/day, moderate PA defined as MVPA 30–45 min/day, high PA defined as MVPA > 45 min/day). Statistical analysis was performed using a Mann–Whitney U and Kruskal–Wallis test, Spearman correlation and mediation analysis. BDI-II scores and MVPA values of in- and outpatients were comparable, but fitness differed between the two groups. Analysis of the outpatient group showed a negative correlation between BDI-II and MVPA. No association of inpatient MVPA and psychopathology was found. General habitual well-being and self-esteem mediated the relationship between outpatient MVPA and BDI-II. The level of depression determined by the BDI-II score was significantly higher in the outpatient low- and moderate PA subgroups compared to outpatients with high PA. Fitness showed no association to depression symptoms or well-being. To ameliorate depressive symptoms of MDD outpatients, intervention strategies should promote habitual MVPA and exercise exceeding the duration recommended for general health (≥ 30 min/day). Further studies need to investigate sufficient MVPA strategies to impact MDD symptoms in inpatient settings. Exercise effects seem to be driven by changes of well-being rather than increased physical fitness.
Thesis
Les patients atteints de schizophrénie (SZ) présentent un risque de morbi-mortalité cardiovasculaire élevé en lien notamment avec une capacité cardiorespiratoire (CCR) réduite et un mode de vie sédentaire. Par ailleurs, bien que les antipsychotiques puissent réduire les symptômes positifs, leur efficacité sur les symptômes négatifs reste limitée et ils sont bien souvent associés à des effets indésirables cardiométaboliques. L’activité physique (AP) a démontré des effets bénéfiques à la fois sur la santé physique et mentale chez les SZ comme présenté dans notre revue de la littérature. Cependant, certains programmes d’AP classiques en face-à-face se heurtent à des taux d’abandon élevés ou à une accessibilité réduite. Ainsi, les objectifs de cette thèse étaient d’évaluer la faisabilité, l’acceptabilité et les bénéfices d’un programme d’AP adaptée à distance utilisant la visioconférence (e-APA) comparativement à un programme d’éducation à la santé (e-ES) sur la condition physique, le niveau d’AP et de comportement sédentaire, les variables physiologiques, biologiques et cliniques chez des SZ et des témoins volontaires sains (TVS) dont le protocole d’étude a fait l’objet d’une publication. Nous avons mis en évidence que l’e-APA est faisable et acceptable chez les SZ avec un faible taux d’abandon et un taux de participation élevé. Notre résultat principal montre une amélioration de la CCR chez les SZ recevant l’e-APA comparativement à ceux du groupe éducation à la santé ainsi qu’une réduction des comportements sédentaires et du LDL-cholestérol. Enfin, l’e-APA réduit la symptomatologie psychotique et les symptômes négatifs, en particulier la dimension avolition-apathie. Pour conclure, ces résultats soulignent que l’e-APA représente une stratégie thérapeutique adjuvante novatrice, originale, sûre et efficace chez les SZ, laquelle nécessite des explorations supplémentaires pour son application en pratique clinique.
Article
Amaç: Bu çalışmada; Sürekli Eylem Süreci Yaklaşımı (SESY) modelinden geliştirilen Fiziksel Aktivite Envanterinin Türkçeye uyarlama çalışması yapılarak geçerlik ve güvenirliğinin test edilmesi amaçlanmıştır. Yöntem: Fiziksel aktivite envanterinin Türkçeye uyarlanmasında Dünya Sağlık Örgütü’nün önerdiği ölçeklerin adaptasyon ve çeviri süreci prosedürü izlendi. Bu prosedür çerçevesinde envanter çeviri-geri çeviri yöntemiyle Türkçeye çevrilmiştir. Envanterin Türkçeye uyarlanmasında yapı geçerliliğini incelemek için açıklayıcı ve doğrulayıcı faktör analizi kullanılmıştır. Güvenilirlik birleşik güvenirlik (CR) değeri ile belirlenmiş, ayrıca yakınsak ve ayırt edici geçerlik irdelenmiştir. Bulgular: Açımlayıcı faktör analizinde motivasyonel fazdaki “algılanan risk ölçeği” hariç özgün envanterde olduğu gibi tüm ölçeklerin tek boyutlu bir yapıda olduğu görülmüştür. Motivasyonel fazdaki “algılanan risk ölçeği” dışındaki tüm ölçeklerin CR değerleri oldukça yüksektir. Motivasyonel ve gönüllü fazı oluşturan ölçeklerin ayırt edici ve yakınsak geçerliğe sahip oldukları değerlendirilmiştir. Sonuç: Bu araştırmanın bulgularına göre fiziksel aktivite envanterinin geçerli ve güvenilir sonuçlara sahip olduğu belirlenmiştir. Türkiye’de şizofreni hastalarında bu model çerçevesinde fiziksel aktivite davranışının belirleyicilerini ortaya koymaya yönelik yapılacak çalışmalarda bu envanterin kullanılabileceği söylenebilir.
Article
Background: Psychotic-like experiences (PLEs) constitute subthreshold symptoms of psychotic disorders, and belong to five distinct dimensions: Positive, Negative, Depressive, Mania and Disorganization. PLEs are associated with various psychiatric disorders. However, few studies examined their association with physical disorders. Objective: Our aims were (1) to assess the associations between various physical disorders and PLEs in a U.S. representative sample, and (2) to examine these associations according to the five dimensions of PLEs. Method: We used data from the wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II), a large national sample representative of the US population (N = 34,653). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule 4. Twenty-two PLEs were examined. Lifetime prevalence and adjusted Odds-Ratio (aOR) reflecting the association of sixteen physical disorders (including notably metabolic conditions and heart diseases) with PLEs were calculated. Results: All studied physical disorders were associated with the presence of PLEs. Particularly the presence of any physical condition, any heart disease and diabetes were more frequent in participants with at least one PLE compared with the group without any PLE (aOR = 1.74, 95% CI = 1.62-1.87, aOR = 1.44, 95% CI = 1.33-1.55 and aOR = 1.38, 95% CI = 1.24-1.54, respectively). Almost all physical disorders were associated with the five dimensions of PLEs. Conclusions: PLEs were associated with a large range of physical disorders, with a gradual dose effect. To assess PLEs in the general population could help with the screening of subjects with physical disorders.
Chapter
Patients with schizophrenia experience increased morbidity and mortality and have an approximately 20% shorter lifespan. Patients with schizophrenia also have a relatively increased prevalence of cardiometabolic risk factors, such as obesity, type 2 diabetes, hypertension, hyperglycemia, and dyslipidemia. The odds ratio (OR) for metabolic syndrome in patients with chronic schizophrenia compared to the general population was 2.35. Although the individual differences of these metabolic disturbances have been observed, an understanding of the underlying mechanisms is still uncertain. A meta-analysis demonstrated that approximately 40% of patients with schizophrenia and related disorders have abnormalities in lipid metabolism. This chapter reviews the association between antipsychotics and dyslipidemia in patients with schizophrenia and the appropriate monitoring and interventions to address metabolic disorders in this population. Olanzapine use was associated with nearly a five-fold increase in the odds of developing hyperlipidemia compared with no antipsychotic exposure in database studies. In meta-analyses, total cholesterol level increased with quetiapine, olanzapine, and clozapine. Further prospective studies are necessary on the association between schizophrenia and lipid metabolism including various factors such as age, weight, gender, diet, exercise, and race that may affect lipid metabolism. In addition, regular monitoring is important in clinical settings.
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Abnormal glucose and lipid metabolism is common in antipsychotic-naive first-episode patients with schizophrenia, but it is unclear whether these changes can already be seen in premorbid or prodromal period, before the first psychotic episode. We examined insulin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride trajectories in children and adolescents (9-18 years old), who were later diagnosed with schizophrenia, any non-affective psychosis (NAP) or affective disorder (AD). The study population consisted of a general population-based cohort "The Cardiovascular Risk in Young Finns Study", started in 1980 (n = 3596). Psychiatric diagnoses were derived from the Health Care Register up to the year 2018. Multivariate statistical analysis indicated no significant differences in insulin or lipid levels in children and adolescents who later developed schizophrenia (n = 41) compared to the cohort control group (n = 3202). In addition, no changes in these parameters were seen in the NAP (n = 74) or AD (n = 156) groups compared to the controls, but lower triglyceride levels in childhood/adolescence associated with earlier diagnosis of psychotic disorder in the NAP group. Taken together, our results do not support any gross-level insulin or lipid changes during childhood and adolescence in individuals with later diagnosis of schizophrenia-spectrum disorder. Since changes in glucose and lipid metabolism can be observed in neuroleptic-naive patients with schizophrenia, we hypothesize that the more marked metabolic changes develop during the prodrome closer to the onset of the first psychotic episode. The findings have relevance for studies on developmental hypotheses of schizophrenia.
Article
Purpose The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. Methods A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. Results A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. Conclusions Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. • IMPLICATIONS FOR REHABILITATION • Height and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ). • The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness. • Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.
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Metabolic syndrome (MetS) is a cluster of parameters encompassing the most dangerous heart attack risk factors, associated with increased morbidity and mortality. It is highly prevalent in recent-onset psychosis (ROP) patients. In this pilot study, we evaluated MetS parameters (fasting glucose, high-density lipoprotein (HDL) cholesterol (HDL-c), fasting triglycerides, waist circumference, and systolic and diastolic blood pressure), clinical symptoms, pharmacological treatment, lifestyle, and inflammatory markers in 69 patients with ROP and 61 healthy controls (HCs). At baseline, waist circumference (p = 0.005) and fasting triglycerides (p = 0.007) were higher in patients with ROP than in HCs. At the 1-year follow-up, patients showed clinical improvement, with a reduction in the positive and negative syndrome scale (PANSS) score (p < 0.001), dietary intake (p = 0.001), and antipsychotic medication dose (p < 0.001); however, fasting glucose (p = 0.011), HDL-c (p = 0.013) and waist circumference worsened (p < 0.001). We identified sex, age, BMI, dietary intake, physical activity, daily tobacco use, daily cannabis use, and antipsychotic doses as risk factors contributing to baseline MetS parameters. After 1-year follow-up, those factors plus the PANSS and Calgary Depression Scale for Schizophrenia (CDSS) scores were associated with MetS parameters. Further studies are needed to understand the contributions of the studied risk factors in patients with ROP at onset and during disease progression.
Article
Background Severe paranoia is likely to limit engagement in physical activities. In this study we set out to examine for the first time the activity profiles of patients with current persecutory delusions and the associations with psychiatric symptoms. Method Seventy-five patients with persecutory delusions in the context of non-affective psychosis wore a pedometer for seven days. Participants completed measures of meaningful activity, mobility, and psychiatric symptoms. Latent class analysis was used to identify physical activity profiles. Results Three distinct activity profiles emerged: a mobile but inactive group (n = 47, 63%) (mean daily step count = 6453, SD = 3348), an immobile and inactive group (n = 20, 27%) (mean daily step count = 4205, SD = 2442), and a mobile and active group (n = 8, 11%) (mean daily stepcount = 18396, SD = 5715). The groups did not significantly differ in their levels of paranoia, anhedonia, psychological wellbeing, insomnia, beliefs about self or others, or safety-seeking behaviours. There were significant group differences in depression and number of physical health appointments, with the immobile and inactive group showing higher levels of both. There were indications of group differences in body mass index, hours worked, hallucinations, and worry. Conclusion There are likely to be different physical activity profiles for patients with current psychotic experiences. The majority of people with persecutory delusions are physically inactive, but a small minority are highly active. In those patients who have low activity levels, there is a potentially important distinction in self-reported mobility, which warrants further investigation. Treatments designed to improve physical activity levels may need to tailor by activity profile.
Article
Importance: People with chronic mental illness (CMI) are at high risk of poor cardiorespiratory fitness as a result of sedentary behavior and physical inactivity. Occupational therapy practitioners play a key role as advocates for positive lifestyle change for people with CMI. Objective: To determine the relationships between occupational therapy activities and cardiorespiratory fitness among inpatients with CMI. Design: This retrospective research included three phases: descriptive cohort, case-control, and cross-sectional studies. Setting: Psychiatric inpatient facility. Participants: Inpatients with CMI, ages 18 to 65 yr (N = 325). Outcomes and measures: Data were collected over a 12-mo period. Each daily occupational therapy activity performed by participants was converted to energy expenditure (in kcal). Cardiorespiratory fitness was measured by means of the 3-Minute Step Test. Results: After daily occupational therapy activities, significantly more participants increased cardiorespiratory fitness than declined (McNemar χ2 [1] = 29.18, p < .05). Prevocational activities and moderate- to high-intensity exercises met the optimal energy expenditure level (>352 kcal) necessary to achieve an increase in cardiorespiratory fitness. Conclusions and relevance: Occupational therapists in psychiatric inpatient settings should prescribe individualized occupation-based or physical activities that meet the optimal daily energy expenditure for each client to improve their cardiorespiratory function. What This Article Adds: This study is one of the first attempts to explore cardiorespiratory fitness outcomes after daily occupational therapy activities for people with CMI. Physical benefits unfolded throughout psychiatric care, echoing the profession's stance on holistic practice.
Article
Purpose: Healthy lifestyle interventions can improve the health of people with serious mental illness (SMI). Little is known whether demographic variables moderate the effectiveness of these interventions on health outcomes. Method: Data from an effectiveness trial of a peer-led healthy lifestyle intervention (PGLB) for people with SMI examine whether age, racial/ethnic minoritized status, and gender moderated the effectiveness of PGLB compared to usual care (UC) in achieving clinically significant improvements in weight, cardiorespiratory fitness, and cardiovascular disease (CVD) risk reduction. Results: Compared to UC, PGLB was most beneficial for participants age 49 and younger for achieving clinically significant weight loss and for racial/ethnic minoritized communities for achieving clinically significant weight loss and reductions in CVD risk. Conclusions: These findings suggest the impact of healthy lifestyle interventions for people with SMI may not be uniform and adaptations may be needed to make these interventions responsive to the needs of diverse populations.
Article
The World Health Organization (WHO) recommends adults complete 150-300 min per week of moderate physical activity or 75-150 min of vigorous physical activity or an equivalent combination of both, to optimize health. To explore the factors associated with adequate MVPA in stabilized outpatients with schizophrenia. 425 stabilized outpatients were recruited in the national FACE-SZ cohort between 2015 and 2018 were evaluated with the International Physical Activity Questionnaire and a 1-day long standardized battery. We explored in multivariate analyses the clinical and pharmacological factors associated with MVPA (model 1) and the biological factors and patient-reported outcomes (model 2). Overall, only 86 (20.2%) of the 425 participants achieved the recommended MVPA threshold. In model 1, the adequate MVPA group was associated with younger age, mood stabilizers prescription and adherence to treatment, independent of sex, positive and depressive symptoms, first-generation antipsychotics prescription, anxiolytic medication, and akathisia. In model 2, adequate MVPA was associated with better glycemic and lipidic profile and better physical and psychological well-being, self-esteem, sentimental life, and resilience independently of age, sex, and current psychotic severity. The expert centers recommend the importance of promoting promote effective MVPA programs for stabilized patients with schizophrenia. Interventions studies suggest that MVPA may be a useful strategy to maximize physical and psychological well-being and self-esteem and potentially to prevent or manage metabolic disturbances.
Article
Background Excess morbidity among patients with schizophrenia has been linked to physical inactivity. Unfortunately, very few patients with schizophrenia engage in a health-enhancing level of physical activity (PA). There are geographic and cultural variations in levels of PA. The aim of this study was to examine PA levels in Nigerian patients with schizophrenia and to identify the clinical and sociodemographic correlates of PA in such patients. Methods The patients were recruited from the Department of Psychiatry, University College Hospital, Ibadan, and the Psychiatry Unit of the State Hospital, Adeoyo, Ibadan, Nigeria. We assessed their physical activity (PA) with the International Physical Activity Questionnaire (IPAQ) Short Form. The symptom severity of patients with schizophrenia was assessed with the Positive and Negative Syndrome Scale (PANSS). Anthropometric measures such as waist circumference, weight and height were also taken. We then explored the factors that were independently associated with PA using binary logistic regression models. Results Two hundred and fifteen patients with schizophrenia were included in the study. The majority of the participants 143 (67.1%) had a low level of PA. Physical activity was associated with the remission status of the participants (P = 0.03). The level of education (r = −0.18 p = 0.01), waist circumference (r = −0.17p = 0.02) and the severity of depression (r = −0.15 p = 0.03), were inversely correlated with the level of physical activity. Social and occupational functioning were positively correlated with the level of physical activity(r = 0.24 p < 0.01). Psychopathology, namely excitement (P4) on the PANSS scale was positively correlated with PA (r = 0.18 p = 0.01), while a lack of judgment and lack of insight were negatively correlated with PA(r = −0.14 p = 0.04). The level of education, waist circumference, social and occupational functioning were independently associated with PA (all p < 0.05). Conclusion The level of physical activity in the majority of patients with schizophrenia from Nigeria is low. Such physical activity is associated with certain sociodemographic and clinical correlates. These can be foci of targeted intervention to improve PA.
Article
Background: Poor mental health is a state of psychological distress that is influenced by lifestyle factors such as sleep, diet, and physical activity. Compulsivity is a transdiagnostic phenotype cutting across a range of mental illnesses including obsessive-compulsive disorder, substance-related and addictive disorders, and is also influenced by lifestyle. Yet, how lifestyle relates to compulsivity is presently unknown, but important to understand to gain insights into individual differences in mental health. We assessed (a) the relationships between compulsivity and diet quality, sleep quality, and physical activity, and (b) whether psychological distress statistically contributes to these relationships. Methods: We collected harmonized data on compulsivity, psychological distress, and lifestyle from two independent samples (Australian n = 880 and US n = 829). We used mediation analyses to investigate bidirectional relationships between compulsivity and lifestyle factors, and the role of psychological distress. Results: Higher compulsivity was significantly related to poorer diet and sleep. Psychological distress statistically mediated the relationship between poorer sleep quality and higher compulsivity, and partially statistically mediated the relationship between poorer diet and higher compulsivity. Conclusions: Lifestyle interventions in compulsivity may target psychological distress in the first instance, followed by sleep and diet quality. As psychological distress links aspects of lifestyle and compulsivity, focusing on mitigating and managing distress may offer a useful therapeutic approach to improve physical and mental health. Future research may focus on the specific sleep and diet patterns which may alter compulsivity over time to inform lifestyle targets for prevention and treatment of functionally impairing compulsive behaviors.
Article
Background Exercise offers improvement to physical and mental health symptoms as well and cognitive function in patients with psychosis. However, patients with psychosis are often less ready to benefit from exercise intervention because of the difficulties in motivation. This study aimed to examine the effectiveness of adjunctive motivational coaching on exercise intervention in women with psychosis in Hong Kong. Methods From a community mental health programme for women, patients with a diagnosis of psychotic disorder (within 5 years of first onset) were randomly allocated to receive 12 30-minute sessions of motivational coaching or psychoeducation in a group format. Both groups additionally received exercise intervention sessions consisting of yoga, stretching and high-intensity interval training. Primary outcome was the total physical activity level measured by the International Physical Activity Questionnaire. Results Fifty-seven patients (mean [SD] age, 34.47 [12.44] years) were randomised into motivational coaching ( n = 30) or psychoeducation ( n = 27) treatment groups. The motivational coaching group had a significantly higher total physical activity level (4601.67 [686.59] vs 2524.82 [723.73] metabolic equivalent task-min/week, r ² = 0.473, p = 0.04) after the intervention and at 6 months post-intervention. Moderate and light physical activity levels were significantly higher in the motivational coaching group after intervention and at 6 months, respectively. Additionally, symptoms of bizarre behaviour were improved in the motivational coaching group at 6 months. Younger, unemployed, unmarried and those with longer durations of untreated psychosis generally showed larger improvements in the motivational coaching group. Conclusion Motivational coaching may augment the effects of exercise interventions, as reflected by higher physical activity participation. Motivational coaching augmentation has the potential to further improve exercise intervention outcomes.
Conference Paper
La reducida esperanza de vida de los pacientes con TMG se encuentra agravada por la alta prevalencia de enfermedades cardiovasculares y metabólicas propiciadas por un estilo de vida poco saludable y bajos niveles condición física. La falta de motivación y la prevalencia de síntomas negativos, suponen un gran obstáculo para la realización de actividad física, reduciendo la adherencia y elevando la tasa de abandono en programas de ejercicio físico. Los exergames se plantean como una terapia factible y eficaz en personas con TMG. El uso de esta tecnología mejora la adherencia y motivación hacia la actividad física, generando beneficios a nivel físico mental y social. El objetivo de la intervención propuesta será promover la adopción y mantenimiento de un programa de actividad física a través de los exergames, así como sus estudiar sus beneficios en el estilo de vida, condición física y parámetros somáticos en personas con TMG. Se realizará mediante un estudio experimental controlado y aleatorio de dos grupos paralelos con una duración de 12 semanas. El diseño, control y supervisión por parte de profesionales de la actividad física dota de una mayor calidad metodológica al estudio, generando enfoque más práctico y objetivo sobre los beneficios de esta terapia coadyuvante en personas con psicosis. La gamificación de la actividad física a través de los exergames permite eliminar barreras y potenciar los facilitadores que modulan la adherencia y mantenimiento de la actividad física, generando unos mayores beneficios en esta población.
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Background There is limited evidence on interventions to minimise weight gain at clozapine commencement. We compared the effect of adjunctive metformin versus placebo at clozapine initiation. Methods People with schizophrenia commencing on clozapine were randomised to either metformin or placebo for 24 weeks. The primary outcome was difference in the change of body weight. Secondary outcomes included comparative rates of weight gain of more than 5%, overall weight gain/loss, and differences in metabolic and psychosis outcomes. Results The study was closed prematurely in March 2020 due to COVID-19 restrictions. Ten participants were randomised to each of the metformin and placebo groups. Eight metformin group and five placebo group participants completed the trial and were included in the analysis. The study was insufficiently powered to detect difference between the metformin and placebo groups for the primary outcome of change in weight (0.09 kg vs 2.88 kg, p = 0.231). In terms of secondary outcomes, people in the metformin group were significantly less likely to gain >5% of their body weight (12.5% vs 80%, p = 0.015) and were more likely to lose weight (37.5% vs 0% p = 0.024) compared to placebo. There was no difference between the groups in terms of adverse drug reactions (ADRs). Conclusion While limited by the forced premature closure of the trial due to COVID19, the findings from this randomised controlled trial are promising. Clozapine and metformin co-commencement may be a promising treatment to prevent clozapine-associated weight gain, especially given the low rates of ADRs associated with metformin. This supports the consideration of use of metformin to prevent weight gain in people initiated on clozapine; however, further studies are needed to confirm this finding. Trial registration ACTRN12617001547336
Article
Schizophrenia is associated with increased prevalence of diabetes. However, risk of diabetes complications as well as the impact of complication burden and patterns on subsequent mortality risk in schizophrenia patients with co-existing diabetes is understudied. This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68,682 patients with incident diabetes only (comparison group) between 2001 and 2016 in Hong Kong, using territory-wide medical-record database of public healthcare services. Complications were measured by Diabetes Complications Severity Index (DCSI), which stratified complication burden into 6 levels (DCSI score=0, 1, 2, 3, 4, or ≥5). Associations of diabetes complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns), with all-cause mortality rate in schizophrenia were evaluated using Cox proportional-hazards models. Schizophrenia group had comparable macrovascular (adjusted OR 0.99 [95% CI 0.92–1.06]) and lower microvascular (0.79 [0.73–0.86]) complication rates relative to comparison group. Mortality risk ratio for schizophrenia was elevated at all complication burden levels, which conferred incremental impact on excess mortality in both groups. Cardiovascular diseases (1.60 [1.45–1.77]) and cerebrovascular-metabolic diseases (2.74 [1.25–5.99]) were associated with the highest differential mortality in schizophrenia among various specific complications and complication combinations, respectively. Our results indicate that schizophrenia patients with co-existing diabetes are at increased risk of excess mortality relative to those with diabetes alone, regardless of complication burden levels. Implementation of multilevel, targeted interventions is needed to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.
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Background: People with psychosis experience cardiometabolic comorbidities, including metabolic syndrome, coronary heart disease and diabetes. These physical comorbidities have been linked to diet, inactivity and the effects of the illness itself, including disorganisation, impairments in global function and amotivation associated with negative symptoms of schizophrenia or co-morbid depression. Methods: We aimed to describe the dietary intake, physical activity (PA) and sedentary behaviour patterns of a sample of patients with established psychosis participating in the Improving Physical Health and Reducing Substance Use in Severe Mental Illness (IMPaCT) randomised controlled trial, and to explore the relationship between these lifestyle factors and mental health symptomatology. Results: A majority of participants had poor dietary quality, low in fruit and vegetables and high in discretionary foods. Only 29.3% completed ⩾150 min of moderate and/or vigorous activity per week and 72.2% spent ⩾6 h per day sitting. Cross-sectional associations between negative symptoms, global function, and PA and sedentary behaviour were observed. Additionally, those with more negative symptoms receiving IMPaCT therapy had fewer positive changes in PA from baseline to 12-month follow-up than those with fewer negative symptoms at baseline. Conclusion: These results highlight the need for the development of multidisciplinary lifestyle and exercise interventions to target eating habits, PA and sedentary behaviour, and the need for further research on how to adapt lifestyle interventions to baseline mental status. Negative symptoms in particular may reduce patient's responses to lifestyle interventions.
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Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity . Nevertheless, participants encountered challenges ; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation . YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.
Article
The transition to menopause, usually occurring between the ages of 40 and 55, is a time when women are particularly vulnerable. When preexisting mental illness is present, symptoms are often amplified during this period. Moreover, women with mental illnesses experience menopausal symptoms similarly to healthy women. In this narrative review we summarize the current data regarding menopause in women with schizophrenia, schizoaffective disorder, and bipolar disorder, as well as current standards of management and care. The management of chronic disease in women suffering from severe mental illness is also considered.
Article
Purpose To find suggestions for a future definitive randomized control trial and examine the effects of physical exercise on neurocognition in schizophrenia. Design and Methods Patients hospitalized with schizophrenia were randomly assigned to exercise (n = 5) or control (n = 17) groups. The experimental group performed an exercise regimen for 8 weeks. Following intervention, demographics, psychiatric symptoms, and neurocognitive functions were examined. Findings The patients in the control and exercise groups, 14 and 4, respectively, showed significant differences in hospitalization duration and negative symptoms. After controlling both, neurocognition improved in the exercise group compared with the control group. Practice Implications Mild-intensity physical exercise improves global neurocognition in schizophrenic inpatients and could lead to earlier release.
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Background People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research ; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
Article
Background Sedentary lifestyle is a significant contributor to poor outcomes in people with psychotic disorders. However, little is known about the extent of routine participation in specific sports and fitness activities among those who do take part. We investigated the frequency, intensity, time and type of sports and fitness activities (“fitness”) completed by people with psychotic disorders in their daily life and explored correlates associated with fitness participation. Methods We conducted a cross-sectional survey among out-patients with psychotic disorders (n = 529) recruited from six different NHS sites in England. Subjective participation in fitness activities during the previous week was assessed by an adaptation of the UK Time Use Survey. The main outcome was whether participants met the minimum World Health Organization recommendations for moderate intensity physical activity (≥150 min/week) through fitness. Poisson regression models with robust error variance were used to examine associations of this outcome with participant variables. Results In total, 267 (52.2%) participants reported taking part in routine fitness activities in the previous week, many of whom did so alone (n = 163, 59.1%). Only 21.5% (n = 114) completed ≥150 min of fitness activities in the previous week. The likelihood of attaining these recommendations was lower among participants who were female, older in age, in a relationship, unemployed and with fewer social contacts. Conclusion Mental health services promoting physical activity interventions among people with psychotic disorders may need to modify their approaches based on previous patient preference and increase their focus on sub-groups of patients who are less likely to routinely engage in fitness activities.
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Aim: Exercise can improve psychiatric symptoms, neurocognitive functioning and physical health in schizophrenia. However, the effects in early psychosis have not been explored. This study aimed to assess the feasibility of an exercise intervention for early psychosis and to determine if it was associated with changes in physical and mental health. Methods: Thirty-one patients with first-episode psychosis (FEP) were recruited from early intervention services to a 10-week exercise intervention. The intervention group received individualized training programmes, aiming to achieve ≥90 min of moderate-to-vigorous activity each week, using exercise programmes tailored to individual preferences and needs. A comparison FEP sample from the same services (n = 7) received treatment as usual. Results: Rates of consent and retention in the exercise group were 94% and 81%, respectively. Participants achieved an average of 107 min of moderate-to-vigorous exercise per week. Positive and Negative Syndrome Scale total scores reduced by 13.3 points after 10 weeks of exercise, which was significantly greater than the treatment as usual comparison group (P = 0.010). The greatest differences were observed in negative symptoms, which reduced by 33% in the intervention group (P = 0.013). Significant improvements were also observed in psychosocial functioning and verbal short-term memory. Increases in cardiovascular fitness and processing speed were positively associated with the amounts of exercise achieved by participants. Conclusion: Individualized exercise training could provide a feasible treatment option for improving symptomatic, neurocognitive and metabolic outcomes in FEP.
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Objectives: The purpose of this report is to describe the impact of a videogame-based pilot physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA, USA) on physical activity in older adults with schizophrenia. Methods: In this one group pre-test, post-test pilot study, 20 participants played an active videogame for 30 min, once a week for 6 weeks. Physical activity was measured by self-report with the Yale Physical Activity Survey and objectively with the Sensewear Pro armband at enrollment and at the end of the 6-week program. Results: There was a significant increase in frequency of self-reported vigorous physical activity. We did not detect a statistically significant difference in objectively measured physical activity although increase in number of steps and sedentary activity were in the desired direction. Conclusion: These results suggest participants' perception of physical activity intensity differs from the intensity objectively captured with a valid and reliable physical activity monitor.
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Research Physicalactivityandsedentary behaviourinoutpatientswith schizophrenia:Asystematic reviewandmeta-analysis Aims: To identify, appraise and synthesise evidence on the level of physical inactivity or activity and its moderators in outpatients with schizophrenia. Method: A systematic search strategy was undertaken and included eight electronic databases. Searches were undertaken using a subject and text-word search strategy between the dates from each databases' inception to September 2012. Two independent reviewers determined study eligibility. Data extraction detailed the level and time spent in physical activity. Results: One hundred and sixty three records were screened, and 12 studies (n=628) met the inclusion criteria. A meta-analysis identified higher levels of sedentary activity (N=2; n=140; z=44.1; P<0.001) and low categories of physical activity (N=2; n=140; z=147,306; P<0.001), and lower levels of moderate (N=3; n=300; z=-5.1; P<0.001) and vigorous (n=3; n=220; z=-3.2; P=0.001) physical activity categories when comparing patients with schizophrenia to healthy age-and gender-matched controls. Meta-regression found no significant association between moderate and vigorous physical activity with age (P=0.08; P=0.14 respectively) and gender (P=0.08; P=0.14 respectively) as the moderators. Conclusion: The current study is the first to provide meta-analytic evidence for the sedentary behaviour and lack of physical activity in outpatients with schizophrenia.
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Objectives The purpose of this report is to describe the impact of a videogame-based pilot physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA, USA) on physical activity in older adults with schizophrenia. Methods In this one group pre-test, post-test pilot study, 20 participants played an active videogame for 30 min, once a week for 6 weeks. Physical activity was measured by self-report with the Yale Physical Activity Survey and objectively with the Sensewear Pro armband at enrollment and at the end of the 6-week program. Results There was a significant increase in frequency of self-reported vigorous physical activity. We did not detect a statistically significant difference in objectively measured physical activity although increase in number of steps and sedentary activity were in the desired direction. Conclusion These results suggest participants’ perception of physical activity intensity differs from the intensity objectively captured with a valid and reliable physical activity monitor.
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The aims were to examine the feasibility of and adaptations to endurance training in persons diagnosed with schizophrenia and to address the question whether the principles and beneficial effects of endurance training established in the healthy population apply also to patients with schizophrenia. In this controlled interventional study, 22 patients with schizophrenia and 22 healthy controls performed a standardized aerobic endurance training on bicycle ergometers over 12 weeks. Another group of 21 patients with schizophrenia played table soccer. Endurance capacity was measured with incremental cycle ergometry before and after the intervention and 3 months later. A specific set of outcome parameters was defined. The training stimuli can be assumed to be similar in both endurance groups. Endurance capacity improved significantly in the endurance groups, but not in the table soccer group. Patients and healthy controls showed comparable adaptations to endurance training, as assessed by physical working capacity and maximal achieved power. Differences were found in changes of performance at a lactate concentration of 3 mmol/l. Endurance training was feasible and effective in both groups. The principles and types of training that are usually applied to healthy controls need to be verified in patients with schizophrenia. Nevertheless, patients benefited from endurance training in terms of improvement of endurance capacity and reduction in the baseline deficit in comparison with healthy controls. Therefore, endurance training should be implemented in future therapy programs. These programs need to pay special attention to the differences between patients with schizophrenia and healthy controls.
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The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment. Method Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18���65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria. High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ��� 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS. In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.
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Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders. To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics. We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles. English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. One reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. Mortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders. For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. These estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.
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The typically poor outcomes of schizophrenia could be improved through interventions that reduce cardiometabolic risk, negative symptoms and cognitive deficits; aspects of the illness which often go untreated. The present review and meta-analysis aimed to establish the effectiveness of exercise for improving both physical and mental health outcomes in schizophrenia patients. We conducted a systematic literature search to identify all studies that examined the physical or mental effects of exercise interventions in non-affective psychotic disorders. Of 1581 references, 20 eligible studies were identified. Data on study design, sample characteristics, outcomes and feasibility were extracted from all studies and systematically reviewed. Meta-analyses were also conducted on the physical and mental health outcomes of randomized controlled trials. Exercise interventions had no significant effect on body mass index, but can improve physical fitness and other cardiometabolic risk factors. Psychiatric symptoms were significantly reduced by interventions using around 90 min of moderate-to-vigorous exercise per week (standardized mean difference: 0.72, 95% confidence interval -1.14 to -0.29). This amount of exercise was also reported to significantly improve functioning, co-morbid disorders and neurocognition. Interventions that implement a sufficient dose of exercise, in supervised or group settings, can be feasible and effective interventions for schizophrenia.
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Background The purpose of this review was to consider the impact of being introduced to a sport and sport participation on (a) weight loss and psychiatric symptoms,(b) any other health benefits in people with schizophrenia, supported by quantitative and qualitative findings. Subject and Methods A systematic review in accordance with the PRISMA statement was conducted. Searches were undertaken in January 2014. Articles were eligible that (1) considered the effect (quantitative studies) and experience (qualitative and case studies) of either; being introduced to a ‘sport’ or undertaking a sport activity, (2) included >85% of patients diagnosed with schizophrenia or schizo-affective spectrum disorders according to recognised criteria. Results A total of 10 studies including 5 trials (2*pre-experimental, 2*controlled trials, 1*randomised control trial), 2 qualitative studies and 3 case studies were included (n=185). Two out of 3 studies that considered weight as an outcome measure reported significant reductions in weight and psychiatric symptoms following sports participation. The mean reduction in body mass index (BMI) ranging from -0.7kg.m2 (p<0.001) following 12 weeks of basketball to -1.33 kg.m2 (p < 0.001) after 12-weeks of soccer. The mean reduction in the Positive and Negative Symptoms score ranged from 2.4 points (F=-19.0, p<0.001) following 12 weeks of basketball to 7.4 points (t = -5.0, P < 0.0001) following a 40 week programme of horse riding. A range of secondary health and wellbeing outcomes identified some significant results. Qualitative statements identified that participants had positive experiences from participating in sports. Additional results are identified. Conclusions Sport participation may result in reduced BMI and improve psychiatric symptoms in people with schizophrenia. Sport has the potential to benefit an individual’s quality of life through providing a normalising activity that has meaning and provides achievement, success and satisfaction. Well-designed randomised controlled trials are required to fully determine the health effects of sports participation in schizophrenia.
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Objective To assess the health benefits of outdoor walking groups. Design Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end. Data sources Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013. Eligibility criteria Adults, group walking outdoors with outcomes directly attributable to the walking intervention. Results Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure −3.72 mm Hg (−5.28 to −2.17) and diastolic blood pressure −3.14 mm Hg (−4.15 to −2.13); resting heart rate −2.88 bpm (−4.13 to −1.64); body fat −1.31% (−2.10 to −0.52), body mass index −0.71 kg/m2 (−1.19 to −0.23), total cholesterol −0.11 mmol/L (−0.22 to −0.01) and statistically significant mean increases in VO2max of 2.66 mL/kg/min (1.67–3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37–105.84). A standardised mean difference showed a reduction in depression scores with an effect size of −0.67 (−0.97 to −0.38). The evidence was less clear for other outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as high-density lipids. There were no notable adverse side effects reported in any of the studies. Conclusions Walking groups are effective and safe with good adherence and wide-ranging health benefits. They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity.
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Aim Walking is a popular type of physical activity in individuals with schizophrenia, yet the benefits remain unclear. The aim of this review was to investigate if walking can a) reduce weight and b) have a positive influence on other health parameters in individuals (aged 16 years and over) with schizophrenia spectrum disorders in in- or outpatient settings. Methods A systematic review in accordance with the PRISMA statement was conducted. Major electronic databases were searched from inception till January 2014. Articles were eligible that considered: (a) the effect of a walking intervention; (b) had included at least 75% of the intervention program as walking rather than another type of physical activity; (c) patients formally diagnosed using standard criteria of schizophrenia or schizo-affective spectrum disorders; (d) used outcome measures that captured the patient’s bio-psychosocial health. Two independent authors conducted the searches, extracted data and completed methodological quality and risk of bias assessment. Results A total of 10 trials from three countries were included (n=339). Selection, detection and performance biases were identified consistently within the research. There is some evidence to suggest walking interventions may benefit an individual’s weight, specifically resulting in small reduction in body mass index or body fat in the short term. Evidence for other health outcomes was limited but no adverse events were reported and walking appears to be safe. The data did not provide enough information for a meta-analysis to be conducted. Conclusion Walking is a popular and safe form of physical activity among individuals with schizophrenia spectrum disorders. No harmful effects were reported and small short-term weight reduction was identified. However, the results were not clinically meaningful and should be view with caution because of the medium to high risk of bias. The broader benefits of walking are yet to be established. Despite the methodological limitations in the literature, walking should be encouraged in clinical practice but clinicians may need to adopt motivational strategies to increase adherence.
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A systematic review and meta-ethnographic synthesis exploring the experiences of people with schizophrenia and healthcare professionals (HCPs) towards physical activity was undertaken. Major electronic databases were searched from inception until January 2014. Studies were eligible if they considered the experiences and perceptions of people with schizophrenia or the perceptions of HCPs towards physical activity. All included studies were synthesised within a meta-ethnographic approach, including completing a methodological quality assessment. The search strategy identified 106 articles, 11 of which were included in the final analysis. Eight articles considered patients’ experiences and perceptions, and three articles considered the experiences and perceptions of HCPs. A total of 108 patients and 65 HCPs were included. Three main themes were identified: (1) the influence of identity, culture and the environment on physical activity engagement, (2) access and barriers to participation in physical activity, and (3) the benefits of engaging in physical activity. Aspects within the built, social and political environment as well as aspects of social cognition and perceptual biases influence participation in physical activity for individuals with schizophrenia. Specific recommendations for HCPs are given to help promote physical activity in this population group.
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The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.
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Purpose The purpose of this study was to evaluate the effects of a 16-week group physical activity (PA) program on physical fitness and quality of life in outpatients with schizophrenia. Methods Nineteen outpatients with schizophrenia were divided into experimental (EG) (n=8; mean age 39±7 years) and control (CG) (n=11; mean age 40±6 years) groups. The EG underwent twice a week sessions of a group PA program for a period of 16-weeks. The participants completed a battery of tests at baseline and after 16-weeks, which included the assessment of body composition (dual-energy X-ray absorptiometry), functional exercise capacity (6MWT), physical activity levels (accelerometers), quality of life (WHOQOL-Brief), and anthropometric measures. During the program different strategies were implemented to ensure the participants’ adherence. Results The attendance to the program was 79.7%. In the EG a significant decrease was observed in hip circumference (p = 0.02); a significant increase occurred in moderate to vigorous physical activity (p = 0.05) and in the environment domain (WHOQOL-Brief) (p = 0.02). The improvement in environment domain scores was also associated with a decrease in sedentary behavior (r = -0.82, p = 0.01) in the EG. Conclusions The strategies used during the program promoted a high rate of attendance. PA may have a positive impact on the participants’ ability to perform activities of daily living. This study showed that a group PA program can be successfully implemented for outpatients with schizophrenia and can influence their quality of life and PA levels.
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Background: In addition to the hallmark cognitive and functional impairments mounting evidence indicates that schizophrenia is also associated with an increased risk for the development of secondary complications, in particular cardio-metabolic disease. This is thought to be the result of various factors including physical inactivity and the metabolic side effects of psychotropic medications. Therefore, non-pharmacological approaches to improving brain health, physical health, and overall well-being have been promoted increasingly. Methods: We report on the health-related physical fitness (body composition, blood pressure, heart rate, and aerobic fitness) and lipid profile of persons living with schizophrenia and effective means to address the challenges of exercise training in this population. Results: There was a markedly increased risk for cardio-metabolic disease in 13 persons living with schizophrenia (Age = 31 ± 7 years) including low aerobic fitness (76% ± 34% of predicted), reduced HDL (60% of cohort), elevated resting heart rate (80% of cohort), hypertension (40% of cohort), overweight and obesity (69% of cohort), and abdominal obesity (54% of cohort). Individualized exercise prescription (3 times/week) was well tolerated, with no incidence of adverse exercise-related events. The exercise adherence rate was 81% ± 21% (Range 48%-100%), and 69% of the participants were able to complete the entire exercise training program. Exercise training resulted in clinically important changes in physical activity, aerobic fitness, exercise tolerance, blood pressure, and body composition. Conclusion: Persons living with schizophrenia appear to be at an increased risk for cardio-metabolic disease. An individualized exercise program has shown early promise for the treatment of schizophrenia and the various cognitive, functional, and physiological impairments that ultimately affect health and well-being.
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