Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

doi:10.1016/j.mhpa.2008.11.001

Mental Health and Physical Activity

Volume 2, Issue 1, June 2009, Pages 29-36

https://doi.org/10.1016/j.mhpa.2008.11.001 Get rights and content

Abstract

Purpose

People with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders.

Methods

Eight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise (n = 7) or usual care (control) (n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM.

Results

The exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score (p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score (r = 0.8, p = 0.009) as was reduction in depressive symptoms (r = −0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise (r = −0.93, p = 0.02).

Conclusions

A 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.

Section snippets

Participants and study design

This was a two-group randomized, controlled study. Participants were recruited from the “Impact” program which is an Assertive Community Treatment (ACT) team. Impact clinicians identified possible participants for the research study and obtained permission from these individuals before communicating their names to study personnel. After a detailed description of the study, informed consent was obtained from interested participants. A letter including information on the study and the medical

Participants

Initially study personnel presented a description of the study procedures to 32 potential participants. All met the inclusion criteria and 13 (five females, eight males) agreed to participate (mean age 44.6 ± 2.6 years). Six were randomized to the control group and seven to the exercise group. There were no significant differences in any of the baseline characteristics between groups (Table 1, Table 2, Table 3). The majority of participants (85%) were prescribed atypical antipsychotic medication.

Discussion

There is a dearth of randomized controlled studies in the area of exercise and schizophrenia (Meyer & Brooks, 2000). This study was unique in that it was a community-based AT and RT program for out-patients with mental illness and was designed and implemented by a multidisciplinary team including a registered nurse and social worker from an Assertive Community Treatment Team as well as a cardiac rehabilitation exercise specialist. As hypothesized, the exercise program yielded significant

Conclusion

A 12-week group exercise program of RT and AT results in significant improvements in overall mental health, muscular strength and trends for improvements in 6MWD with no significant change in the control group. Attendance to the group-based exercise sessions at the local community centre (72%) was superior to completion of home-based sessions (35%). Participants attended at least 50% of exercise classes with no dropouts. Among all subjects, improvement in functional exercise capacity was

Acknowledgements

We would like to thank the participants in this study. Additionally we would like to thank Dr. Patricia Cavanagh and Dr. Paul I. Oh for their support with the study and Neville Baker and Catherine Skene, staff members of the ACT team and Anka Brozic for their involvement with the exercise program and testing. We also gratefully acknowledge grants supporting this study and the exercise program resulting from this study, received from the Departments of Allied Health and Psychiatry, University

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¹: Present address: Toronto Western Hospital, 489 College St. Suite 304, Toronto, Ontario M6G 1A5.

View full text

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Participants and study design

Participants

Discussion

Conclusion

Acknowledgements

Chest

American Journal of Medicine

Journal of Clinical Epidemiology

American Thoracic Society statement: Guidelines for the six-minute walk test

American Journal of Respiratory and Critical Care Medicine

Guidelines for Exercise Testing and Prescription

Antipsychotic induced weight gain: A comprehensive research synthesis

The American Journal of Psychiatry

Pilot study: Access to fitness facility and exercise levels in Olanzapine-treated patients

Canadian Journal of Psychiatry

Screening CMHC outpatients for physical illness

Hospital and Community Psychiatry

Effects of exercise on mental and physical health parameters of persons with schizophrenia

Issues in Mental Health Nursing

Changes in physical fitness and all-cause mortality: A prospective study of healthy and unhealthy men

Journal of the American Medical Association

Effects of exercise training on older patients with major depression

Archives of Internal Medicine

The effectiveness of psychiatric rehabilitation at thresholds

Psychosocial Rehabilitation

Psychophysical bases of perceived exertion

Medicine and Science in Sports and Exercise

Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials

Journal of the American Medical Association

The unhealthy lifestyle of people with schizophrenia

Psychological Medicine

Causes of the excess mortality of schizophrenia

British Journal of Psychiatry

Assertive community treatment: An update of randomized trials

Psychiatric Services

Two-, six-, and 12-minute walking tests in respiratory disease

British Medical Journal

Cardiovascular risk factors for people with mental illness

Australian and New Zealand Journal of Psychiatry

Running versus weight lifting in the treatment of depression

Journal of Consulting and Clinical Psychology

Exercise as an adjunct treatment for schizophrenia: A review of the literature

Journal of Mental Health

Exercise as therapy for schizophrenia: An ethnographic study

Journal of Sport and Exercise Psychology

The benefits of an exercise program for people with schizophrenia: A pilot study

Psychiatric Rehabilitation Journal

The effects of aerobic exercise on perceived self-image in post hospitalized schizophrenic patients

Medicine and Science in Sports and Exercise

The 6-minute walk: A new measure of exercise capacity in patients with chronic heart failure

Canadian Medical Association Journal

Structured exercise for persons with serious psychiatric disabilities

Psychiatric Services

Prediction of long-term prognosis in 12,169 men referred for cardiac rehabilitation

Circulation

The Positive and Negative Syndrome Scale for schizophrenia

Schizophrenia Bulletin

Reliability and intensity of the six-minute walk test in healthy elderly subjects

Medicine and Science in Sports and Exercise