Barriers to uptake of physical activity in community-based patients with schizophrenia

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.

Reliability, minimal detectable changes, practice effects and correlates of the 6-min walk test in patients with schizophrenia

We examined the reproducibility of the 6-min walk test (6 MWT) in patients with schizophrenia. Secondary aims were to assess minimal detectable changes and practice effects of the 6 MWT and the presence of clinical conditions that might interfere. From 71 patients with schizophrenia two trials of the 6 MWT, administered within 3 days, were analysed. The intraclass correlation coefficient between the two tests was 0.96. The minimal detectable change was 56.2m for men and 50.2m for women. Body mass index, daily antipsychotic dose, negative and depressive symptoms, resting heart rate, age, smoking behavior and different musculoskeletal complaints were all significantly associated with the distance walked. The 6 MWT can be recommended for evaluating the functional exercise capacity in patients with schizophrenia. Some practice effect could however not be excluded.

Implementing a physical health strategy in a mental health service

OBJECTIVE

The aim of this paper is to describe a comprehensive metabolic monitoring strategy within an Australian public mental health service.

METHODS

Patient physical health was identified as a high priority within the mental health service. A survey of staff attitudes informed the development of metabolic monitoring guidelines and provision of education for clinicians and patients. An audit was subsequently performed to ascertain rates and results of metabolic monitoring, and focus groups helped to understand patient perspectives.

RESULTS

Despite significant barriers to the implementation of routine metabolic monitoring from both staff and patient perspectives, our programme delivered on around 60% coverage of routine monitoring of blood glucose and lipids and 54% on weight measurement. Compliance with measurement of waist circumference was much less (7%).

CONCLUSIONS

To ensure adherence to metabolic monitoring programmes within mental health services, a comprehensive and multifaceted approach is required with ongoing education of both staff and patients.