Diabetes, physical activity participation and exercise capacity in patients with schizophrenia

AIM

The aim of this study was to determine if in schizophrenia patients the presence of diabetes is associated with lower physical activity participation and lower exercise capacity compared to patients with pre-diabetes and to patients without (pre-) diabetes.

METHODS

Schizophrenia patients without (pre-)diabetes (n = 86) were compared with pre-diabetic (n = 10) and diabetic patients (n = 10). Patients were assessed on physical activity participation using the Baecke physical activity questionnaire and on exercise capacity using a 6-min walk test (6MWT).

RESULTS

The three groups were similar in age, sex, mean antipsychotic medication dose, negative and depressive symptoms and smoking behavior. Distance achieved on the 6MWT, however, was approximately 15% shorter (P < 0.05) in patients withdiabetes than in patients without (pre-)diabetes (500.3 ± 76.9 m vs 590.7 ± 101.8 m). Patients with diabetes were also significantly less physically active (P < 0.05). No differences between diabetic and pre-diabetic patients were found. Pre-diabetic patients had a higher body mass index (BMI) than non-diabetic patients (30.0 ± 7.3 vs 24.3 ± 4.3, P < 0.05). An interaction effect with BMI for differences in Baecke (F = 29.9, P < 0.001) and 6MWT (F = 13.0, P < 0.001) scores was seen between diabetic and non-diabetic patients on univariate ANCOVA.

CONCLUSION

The additive burden of diabetes might place patients with schizophrenia at an even greater risk for functional limitations in daily life.

Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis

BACKGROUND

Individuals at clinical high risk (CHR) for psychosis have become a major focus for research designed to explore early predictors of transition to full psychosis. Characterizing differences in neurocognitive (NC) functioning between psychosis converters (CHR-C) and non-converters (CHR-NC) might contribute to the identification of specific NC predictors of psychosis onset. Therefore, the aim of the present meta-analysis was to compare the baseline NC performance between CHR-C and CHR-NC.

METHOD

PubMed (MEDLINE), Web of Science, Embase and reference lists were searched for studies reporting baseline cognitive data of CHR-C and CHR-NC. Included NC tests were classified within the MATRICS - Measurement and Treatment Research to Improve Cognition in Schizophrenia - cognitive domains.

RESULTS

Of 95 studies assessed for eligibility, 9 studies comprising 583 CHR subjects (N CHR-C=195, N CHR-NC=388) met all the inclusion criteria. CHR-C performed significantly worse compared to CHR-NC on 2 MATRICS domains namely working memory (ES=-0.29, 95% CI=-0.53 to -0.05) and visual learning (ES=-0.40, 95% CI=-0.68 to -0.13). For the remaining 4 domains (processing speed, attention/vigilance, verbal learning, reasoning/problem solving) no significant differences between CHR-C and CHR-NC were observed.

CONCLUSION

Based on the current meta-analytic data we might conclude that it is possible to differentiate between CHR-C and CHR-NC with respect to working memory and visual learning. The addition of visual learning and working memory tasks to psychosis regression models might contribute to the predictive power of these models.

Social anxiety in physical activity participation in patients with mental illness: a cross-sectional multicenter study

BACKGROUND

Social anxiety (SA) is a frequent comorbid condition in patients with mental illness. However, no data exist regarding SA in physical activity (PA) situations. The aim of the present study was to measure the level of self-reported SA in PA participation in patients with mental illness compared to healthy controls.

METHODS

Six hundred ninety-three patients with mental illness and 2,888 controls aged between 18 and 65 years completed the Physical Activity and Sport Anxiety Scale (PASAS). Group and gender differences in PASAS scores were tested by ANOVA and Scheffé's post hoc test.

RESULTS

After controlling for gender (P < .05), the patient group (men 40.2 ± 14.4; women 49.2 ± 17) scored higher on the PASAS compared to control group (men 30.6 ± 12.2; women 37.3 ± 13.7). Within both groups, women reported higher levels of SA compared to men.

CONCLUSIONS

Our data indicate that patients with mental illness reported higher levels of SA in PA situations compared to healthy control subjects. Health professionals should consider SA when trying to improve outcome and adherence of patients with mental illness to PA interventions.

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa

PURPOSE

The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa.

METHOD

EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale.

RESULTS

Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported.

CONCLUSIONS

The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia

Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD) and metabolic syndrome (MetS), and as an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated significant differences from controls in whole body balance, explosive leg muscle strength, abdominal muscular endurance, and running speed. Inactive patients scored worse on most Eurofit items than patients walking for at least 30min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness.

A review of physical activity correlates in patients with bipolar disorder

BACKGROUND

Existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental and physical health in patients with bipolar disorder. The present review evaluates systematically quantitative studies of correlates of physical activity in patients with bipolar disorder.

METHODS

We searched EMBASE, PsycINFO, PubMed, and CINAHL from their inception, combining the medical subject headings 'bipolar disorder' or 'mania' or 'manic depression' with 'physical activity' or 'physical inactivity' or 'exercise'.

RESULTS

Out of 40 potentially eligible studies, 11 papers evaluating 26 correlates were included. Correlates that were associated with lower physical activity participation were lower self-efficacy, presence of medical co-morbidity, lower educational status and social isolation. Less consistent variables associated with lower physical activity participation included higher BMI, older age, financial strains, not being connected to a health care service, and minority ethnicity. A larger study sample size was related to a higher proportion of significant associations (p=0.04). Current gaps in literature which need to be examined more in detail are the role of psychiatric symptoms, environmental and policy-level factors.

LIMITATIONS

The diversity of physical activity measures and subject samples prevented us to perform a meta-analysis.

CONCLUSIONS

All significant correlates should be confirmed in prospective studies and interventions to improve the modifiable variables should be developed and evaluated. The reviewed data also demonstrate that validation studies on physical activity measurements are highly needed.

Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients

We aimed to discover whether metabolic complications of schizophrenia (SZ) are present in first episode (FE) and unmedicated (UM) patients, in comparison with patients established on antipsychotic medication (AP).

METHOD

A systematic search, critical appraisal, and meta-analysis were conducted of studies to December 2011 using Medline, PsycINFO, Embase and experts. Twenty-six studies examined FE SZ patients (n = 2548) and 19 included UM SZ patients (n = 1325). For comparison we identified 78 publications involving 24 892 medicated patients who had chronic SZ already established on AP.

RESULTS

In UM, the overall rate of metabolic syndrome (MetS) was 9.8% using any standardized criteria. Diabetes was found in only 2.1% and hyperglycaemia (>100 mg/dl) in 6.4%. In FE, the overall MetS rate was 9.9%, diabetes was found in only 1.2%, and hyperglycaemia in 8.7%. In UM and FE, the rates of overweight were 26.6%, 22%; hypertriglyceridemia 16.9%, 19.6%; low HDL 20.4%, 21.9%; high blood pressure 24.3%, 30.4%; smoking 40.2%, 46.8%, respectively. In both groups all metabolic components and risk factors were significantly less common in early SZ than in those already established on AP. Waist size, blood pressure and smoking were significantly lower in UM compared with FE.

CONCLUSION

There is a significantly lower cardiovascular risk in early SZ than in chronic SZ. Both diabetes and pre-diabetes appear uncommon in the early stages, especially in UM. However, smoking does appear to be elevated early after diagnosis. Clinicians should focus on preventing initial cardiometabolic risk because subsequent reduction in this risk is more difficult to achieve, either through behavioral or pharmacologic interventions.

Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators

OBJECTIVE

Patients with bipolar disorder have high levels of cardiovascular disease risk factors. The presence of metabolic syndrome significantly influences future cardiovascular disease morbidity and mortality. The authors sought to clarify the prevalence and moderators of metabolic syndrome in bipolar patients, accounting for subgroup differences.

METHOD

The authors searched MEDLINE, PsycINFO, EMBASE, and CINAHL through April 2012 for research reporting metabolic syndrome prevalence rates in bipolar patients. Medical subject headings "metabolic syndrome" and "bipolar" were used in the title, abstract, or index term fields. Manual searches were conducted using the reference lists from identified articles.

RESULTS

The search yielded 81 articles in 37 publications (N=6,983). The overall metabolic syndrome rate was 37.3% (95% confidence interval [CI]=36.1-39.0) using any standardized metabolic syndrome criteria. Compared with general population groups, bipolar patients had higher metabolic syndrome rates (odds ratio=1.98; 95% CI=1.74-2.25). In bipolar patients, older age had a modest effect on the metabolic syndrome rate. The strongest moderator was the region in which the study took place, with the highest rates observed in New Zealand and Australia (64.2% [95% CI=38.3-83.9]) and North America (49.3% [95% CI=29.7-69.3]). Metabolic syndrome was significantly more prevalent in patients currently treated with antipsychotics (45.3% [95% CI=39.6-50.9] than in patients who were antipsychotic free (32.4% [95% CI=27.5-37.4]; odds ratio=1.72 [95% CI=1.24-2.38]).

CONCLUSIONS

These findings strongly support the claim that patients with bipolar disorder are at high risk for metabolic syndrome and related cardiovascular morbidity and mortality and require regular monitoring and adequate preventive efforts and treatment for cardio-metabolic risk factors. These findings further suggest that the risk of metabolic syndrome is greater in bipolar patients taking prescribed antipsychotic medication.

Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders--a systematic review and meta-analysis

Individuals with schizophrenia have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant influence upon future morbidity and mortality. We aimed to clarify the prevalence and predictors of metabolic syndrome (MetS) in adults with schizophrenia and related disorders, accounting for subgroup differences. A PRISMA systematic search, appraisal, and meta-analysis were conducted of 126 analyses in 77 publications (n = 25,692). The overall rate of MetS was 32.5% (95% CI = 30.1%-35.0%), and there were only minor differences according to the different definitions of MetS, treatment setting (inpatient vs outpatient), by country of origin and no appreciable difference between males and females. Older age had a modest influence on the rate of MetS (adjusted R(2) = .20; P < .0001), but the strongest influence was of illness duration (adjusted R(2) = .35; P < .0001). At a study level, waist size was most useful in predicting high rate of MetS with a sensitivity of 79.4% and a specificity of 78.8%. Sensitivity and specificity of high blood pressure, high triglycerides, high glucose and low high-density lipoprotein, and age (>38 y) are shown in supplementary appendix 2 online. Regarding prescribed antipsychotic medication, highest rates were seen in those prescribed clozapine (51.9%) and lowest rates of MetS in those who were unmedicated (20.2%). Present findings strongly support the notion that patients with schizophrenia should be considered a high-risk group. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.

An impaired health related muscular fitness contributes to a reduced walking capacity in patients with schizophrenia: a cross-sectional study

BACKGROUND

Patients with schizophrenia report muscle weakness. The relation of this muscle weakness with performing daily life activities such as walking is however not yet studied. The aim of this study was to quantify walking capacity and health related muscular fitness in patients with schizophrenia compared with age-, gender and body mass index (BMI)-matched healthy controls. Secondly, we identified variables that could explain the variability in walking capacity and in health related muscular fitness in patients with schizophrenia.

METHODS

A total of 100 patients with schizophrenia and 40 healthy volunteers were initially screened. Eighty patients with schizophrenia (36.8±10.0 years) and the 40 age-, gender- and body mass index (BMI)-matched healthy volunteers (37.1±10.3 years) were finally included. All participants performed a standing broad jump test (SBJ) and a six-minute walk test (6MWT) and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms.

RESULTS

Patients with schizophrenia did have lower 6MWT (17.9%, p<0.001) [effect size (ES)=-1.01] and SBJ (14.1%, p<0.001) (ES=-0.57) scores. Patients were also less physically active (1291.0±1201.8 metabolic equivalent-minutes/week versus 2463.1±1365.3, p<0.001) (ES=-0.91) than controls. Schizophrenia patients with metabolic syndrome (MetS) (35%) had a 23.9% lower (p<0.001) SBJ-score and 22.4% (p<0.001) lower 6MWT-score than those without MetS. In multiple regression analysis, 71.8% of the variance in 6MWT was explained by muscular fitness, BMI, presence of MetS and physical activity participation, while 53.9% of the variance in SBJ-score was explained by age, illness duration, BMI and physical activity participation.

CONCLUSIONS

The walking capacity and health-related muscular fitness are impaired in patients with schizophrenia and both should be a major focus in daily clinical practice and future research.

Associations between sedentary behaviour and metabolic parameters in patients with schizophrenia

This study examined the association between sedentary behaviour and metabolic parameters among patients with schizophrenia. A total of 76 patients and 38 healthy age-, gender- and BMI-matched volunteers were included. Participants were asked for their overall sitting and physical activity behaviour using the International Physical Activity Questionnaire. Patients were additionally screened for psychiatric symptoms and extrapyramidal side-effects of antipsychotic medication. On average, patients with schizophrenia spent 8.5h per day sitting (versus 6.21h in healthy controls). Patients sitting more than 10.4h per day had a higher BMI, waist circumference and fasting glucose concentrations and experienced more negative and cognitive symptoms than those sitting less than 5.8h per day. Overall sitting time was associated with a significantly greater likelihood of metabolic syndrome. A stepwise backward-elimination multivariate regression analysis demonstrated that sitting time is a significant predictor for BMI. Current results suggest patients with schizophrenia may benefit from reducing total sitting time.

Acute effects of progressive muscle relaxation on state anxiety and subjective well-being in chronic Bulgarian patients with schizophrenia

BACKGROUND

Recently, there has been an interest in the relative effectiveness of progressive muscle relaxation (PMR) within the multidisciplinary treatment of patients with schizophrenia.The present study is aimed at providing evidence on the efficacy of PMR as means of alleviating the state anxiety and psychological distress and a way to increase subjective well-being in chronic patients with schizophrenia.

SUBJECTS AND METHODS

Sixty four schizophrenia patients underwent 2 sessions of PMR. On the third session they were randomly allocated to either the PMR or the reading control condition. The State Anxiety Inventory (SAI) was used to assess state anxiety and the Subjective Exercise Experience Scale (SEES) to assess psychological distress and subjective well-being before and after the third session for both groups.

RESULTS

Our data show a significant time by group interaction for the SAI and SEES (Wilks λ=0.58, p<0.001). Effect sizes for PMR were -0.22 (95%CI=-0.73 to 0.19) for state anxiety, -0.96 (95%CI=-0.41 to -1.43) for psychological stress, and +1.01 (95%CI=0.45 to 1.54) for subjective well-being.

CONCLUSION

The present study provides scientific evidence for the utility of PMR in the chronic psychiatric settings for patients with schizophrenia.

Progressive muscle relaxation in persons with schizophrenia: a systematic review of randomized controlled trials

Objective:

The aim of this systematic review was to assess the effectiveness of progressive muscle relaxation on psychological distress and anxiety symptoms and on response/remission for people with schizophrenia.

Methods:

Randomized controlled trials were considered if they investigated progressive muscle relaxation in patients with schizophrenia. EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL, PEDro and Cochrane Library were searched. The selection of studies, data extraction and quality assessment were performed independently by two reviewers.

Results:

Three randomized controlled trials involving 146 patients met the inclusion criteria. Progressive muscle relaxation can acutely reduce state anxiety and psychological distress and improve subjective well-being. No studies investigated the evidence for progressive muscle relaxation as an add-on treatment for general psychopathology and for positive or negative symptoms. Also, no studies assessed the value of progressive muscle relaxation in longer-term treatment and for relapse prevention. There were no data to draw any conclusions about progressive muscle relaxation in comparison with other treatment modalities. None of the studies encountered adverse events. Dose-response relationships could not be determined.

Conclusion:

Progressive muscle relaxation might be a useful add-on treatment to reduce state anxiety and psychological distress and improve subjective well-being in persons with schizophrenia.

Yoga in schizophrenia: a systematic review of randomised controlled trials

OBJECTIVE

The objective of this systematic review was to assess the effectiveness of yoga as a complementary treatment on general psychopathology, positive and negative symptoms and health-related quality of life (HRQL) for people with schizophrenia.

METHOD

Randomised controlled trials (RCTs) were considered whether they investigated a yoga intervention in patients with schizophrenia. The selection of studies, data extraction and quality assessment were performed independently by two reviewers.

RESULTS

Only three RCTs met the inclusion criteria. Lower Positive and Negative Syndrome Scale (PANSS) total scores and subscale scores for positive and negative symptoms were obtained after yoga compared with exercise or waiting list control conditions. In the same way, the physical, psychological, social and environmental HRQL as measured with the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) increased more significantly after yoga than after exercise or waiting list control conditions. None of the RCTS encountered adverse events. Dose-response relationships could, however, not be determined.

CONCLUSION

Although the number of RCTs included in this review was limited, results indicated that yoga therapy can be an useful add-on treatment to reduce general psychopathology and positive and negative symptoms. In the same way, HRQL improved in those antipsychotic-stabilised patients with schizophrenia following yoga.

The functional exercise capacity is correlated with global functioning in patients with schizophrenia

OBJECTIVE

The 6-minute walk test (6MWT) is commonly used to measure the functional exercise capacity in chronic patients with cardiovascular diseases. The purpose of this study was to determine whether the 6MWT is associated with the global assessment of functioning (GAF) score in patients with schizophrenia.

METHODS

A total of 68 male and 25 female in-patients with schizophrenia (34.6 ± 9.7 years; body mass index = 24.9 ± 4.4) performed a 6MWT and were assessed with the GAF scale and the Psychosis Evaluation tool for Common use by Caregivers (PECC).

RESULTS

The mean distance walked on the 6MWT was 587.3 ± 98.4 m, while the mean GAF score was 52.0 ± 10.4. The Pearson's correlation coefficient between the 6MWT and the GAF score was 0.59 (P < 0.001), indicating a moderate association between both measures. The 6MWT was also significantly related to negative (r = -0.45, P < 0.001), depressive (r = -0.48, P < 0.001) and cognitive (r=, P) symptoms and with body mass index (r = -0.31, P < 0.005), smoking behaviour (r = -0.36, P < 0.001)) and dose of antipsychotic medication (r = -0.38, P < 0.001).

CONCLUSION

Next to the GAF scale, clinicians in in-patient settings should consider incorporating the 6MWT into their test battery to measure the functional consequences of schizophrenia and its treatment.

A systematic review of correlates of physical activity in patients with schizophrenia

OBJECTIVE

The present review evaluates systematically the published quantitative studies of correlates of PA in patients with schizophrenia.

METHOD

EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL and PEDro were searched from their inception to 1 July 2011 combining the medical subject heading 'schizophrenia' with 'physical activity' or 'physical inactivity' or 'exercise' or 'health education' or 'health behaviour' or 'health promotion'.

RESULTS

Out of 68 potentially eligible studies, 25 papers (n = 25,013) evaluating 36 correlates were included. Correlates consistently associated with lower PA participation are the presence of negative symptoms and cardio-metabolic comorbidity. Also, side-effects of antipsychotic medication, lack of knowledge on cardiovascular disease risk factors, no belief in the health benefits, a lower self-efficacy, other unhealthy lifestyle habits and social isolation correlated with lower PA participation. The quality of the PA measurement was not related to the proportion of significant associations (χ(2) = 3.8, P = 0.07). Current gaps in literature that need to be examined more in detail are the role of environmental and policy-level factors on PA participation in patients with schizophrenia.

CONCLUSION

All correlates should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.

A Cognitive- Behavioral Therapeutic Program for Patients With Obesity and Binge Eating Disorder

The goal of this study is to investigate the efficacy of a manualized cognitive-behavioral therapeutic (CBT) approach for patients with obesity and binge eating disorder (BED) on the short and longer term. A prospective study without a control group consisting of three measurements (a baseline measurement and two follow-up assessments up to 5 years after the start of the CBT treatment) was used. A total of 56 patients with obesity and BED (age = 39.7 ± 10-9 years; body mass index [BMI] = 38.5 ± 8.3 kg/m2) participated in the study. BMI, number of binges per week, general psychological well-being, mood, attitude toward one’s body, and loss of control over the eating behavior were evaluated by means of mixed models. Results indicate that a CBT approach offered 1 day a week during an average 7 months produces benefits on eating behaviors, weight, and psychological parameters that are durable up to 3.5 years post treatment.

[The importance of movement-directed interventions in the multidisciplinary treatment of binge eating disorder: an overview]

BACKGROUND

More than three out of four persons with binge eating disorder do not get enough physical exercise.

AIM

To collect scientific evidence of the effects and benefits that movement and physical exercise can have on persons with a binge eating disorder.

METHOD

PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Physiotherapy Evidence Database, the Dutch Journal of Psychiatry (Tijdschrift voor Psychiatrie), het Tijdschrift voor Vaktherapie and Actual Themata derived from psychomotor therapy were screened for the period January 1994 to August 2011. The methodological quality of the studies was determined on the basis of a checklist. Evidence for the effectiveness of the interventions was summarised by best-evidence synthesis.

RESULTS

Eight studies met the inclusion and exclusion criteria. Strong evidence was found for: 1) significant weight-loss after movement interventions; 2) fewer symptoms of depression after a combination of both movement and cognitive behavioural therapy (CBT) than after CBT on its own. There was only limited evidence for 1) the fact that the combination of movement and CBT leads to less eating disorder pathology than does CBT alone; 2) the beneficial effects of yoga on weight-loss as well as on the reduction of eating disorder pathology.There are indications that walking can be helpful in reducing of eating disorder pathology.

CONCLUSIONS

Activities involving movement and physical exercise deserve to play an important role in the multidisciplinary treatment of binge eating disorders.

Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices

BACKGROUND

Despite increased cardiometabolic risk in individuals with mental illness taking antipsychotic medication, metabolic screening practices are often incomplete or inconsistent.

METHOD

We undertook a systematic search and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) meta-analysis of studies examining routine metabolic screening practices in those taking antipsychotics both for patients in psychiatric care before and following implementation of monitoring guidelines.

RESULTS

We identified 48 studies (n=290 534) conducted between 2000 and 2011 in five countries; 25 studies examined predominantly schizophrenia-spectrum disorder populations; 39 studies (n=218 940) examined routine monitoring prior to explicit guidelines; and nine studies (n=71 594) reported post-guideline monitoring. Across 39 studies, routine baseline screening was generally low and above 50% only for blood pressure [69.8%, 95% confidence interval (CI) 50.9-85.8] and triglycerides (59.9%, 95% CI 36.6-81.1). Cholesterol was measured in 41.5% (95% CI 18.0-67.3), glucose in 44.3% (95% CI 36.3-52.4) and weight in 47.9% (95% CI 32.4-63.7). Lipids and glycosylated haemoglobin (HbA1c) were monitored in less than 25%. Rates were similar for schizophrenia patients, in US and UK studies, for in-patients and out-patients. Monitoring was non-significantly higher in case-record versus database studies and in fasting samples. Following local/national guideline implementation, monitoring improved for weight (75.9%, CI 37.3-98.7), blood pressure (75.2%, 95% CI 45.6-95.5), glucose (56.1%, 95% CI 43.4-68.3) and lipids (28.9%, 95% CI 20.3-38.4). Direct head-to-head pre-post-guideline comparison showed a modest but significant (15.4%) increase in glucose testing (p=0.0045).

CONCLUSIONS

In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.

Quality assessment of physical activity recommendations within clinical practice guidelines for the prevention and treatment of cardio-metabolic risk factors in people with schizophrenia

The aim of this review was to assess the quality of physical activity recommendations within clinical practice guidelines for the prevention and treatment of the cardio-metabolic risk factors in schizophrenia. Several databases were searched from their inception through July 2010. The Appraisal of Guidelines for Research and Evaluation instrument was used for the quality assessment. Twelve recommendations met all the in- and exclusion criteria. The overall agreement of the quality assessment using the intraclass correlation coefficient was 0.90. Comparison identified considerable variation in the quality of the content. Based on quality assurance standards, only one of 12 guidelines was recommended. Differences on in-depth analysis suggest a lack of consistency in relation to information about the potential role of physical activity in reducing cardiometabolic risks in schizophrenia. High quality recommendations are highly needed along with specific practical advice for persons with schizophrenia, family members and health care professionals.

International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia

PURPOSE

The excess cardiovascular morbidity associated with schizophrenia is attributed to an interplay between behavioural (physical inactivity, unhealthy diet, substance abuse), genetic and illness related factors, as well as the effects of antipsychotic treatment. Patients have limited access to physical healthcare with less opportunity for cardiovascular risk prevention and treatment programmes than the non-psychiatric population. The aim of this paper is to improve physical activity (PA) within rehabilitation programmes for people with schizophrenia.

METHOD

The development process consisted of: a) systematic literature review on PA in schizophrenia in eight databases up to May 2010; b) review on existing national and international guidelines; c) consensus meetings, and d) formulation of the final consensus document.

RESULTS

There is insufficient evidence for the relative contribution of PA reducing cardio-metabolic risks in people with schizophrenia. Demographical, biological, psychological, cognitive-behavioural, emotional, social and environmental barriers for PA could be identified.

CONCLUSIONS

Although PA outcomes on cardio-metabolic parameters are still unknown, the benefits of physical activity as part of a larger lifestyle programme are sufficient for the recommendation that persons with schizophrenia follow the 2008 U.S. Department of Health and Human Services PA Guidelines with specific adaptations based on disease and treatment-related adverse effects.

Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation

BACKGROUND

Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia.

AIMS

To evaluate the content and quality of screening guidelines for cardiovascular risk in schizophrenia.

METHOD

Systematic review and quality assessment of guidelines/recommendations for cardiovascular risk in people with schizophrenia published between 2000 and 2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE).

RESULTS

The AGREE domain scores varied between the 18 identified guidelines. Most guidelines scored best on the domains 'scope and purpose' and 'clarity of presentation'. The domain 'rigour of development' was problematic in most guidelines, and the domains 'stakeholder involvement' and 'editorial independence' scored the lowest. The following measurements were recommended (in order of frequency): fasting glucose, body mass index, fasting triglycerides, fasting cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood pressure and symptoms of diabetes. In terms of interventions, most guidelines recommended advice on physical activity, diet, psychoeducation of the patient, treatment of lipid abnormalities, treatment of diabetes, referral for advice and treatment, psychoeducation of the family and smoking cessation advice. Compared across all domains and content, four European guidelines could be recommended.

CONCLUSIONS

Four of the evaluated guidelines are of good quality and should guide clinicians' screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement.