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Leroux E, Tréhout M, Reboursiere E, de Flores R, Morello R, Guillin O, Quarck G, Dollfus S. Effects of web-based adapted physical activity on hippocampal plasticity, cardiorespiratory fitness, symptoms, and cardiometabolic markers in patients with schizophrenia: a randomized, controlled study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01818-8. [PMID: 38740618 DOI: 10.1007/s00406-024-01818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Among the lifestyle interventions, the physical activity (PA) has emerged as an adjuvant non-pharmacological treatment improving mental and physical health in patients with schizophrenia (SZPs) and increasing the hippocampus (HCP) volume. Previously investigated PA programs have been face-to-face, and not necessary adapted to patients' physiological fitness. We propose an innovative 16-week adapted PA program delivered by real-time videoconferencing (e-APA), allowing SZPs to interact with a coach and to manage their physical condition. The primary goal was to demonstrate a greater increase of total HCP volumes in SZPs receiving e-APA compared to that observed in a controlled group. The secondary objectives were to demonstrate the greater effects of e-APA compared to a controlled group on HCP subfields, cardiorespiratory fitness, clinical symptoms, cognitive functions, and lipidic profile. Thirty-five SZPs were randomized to either e-APA or a controlled group receiving a health education program under the same conditions (e-HE). Variables were assessed at pre- and post-intervention time-points. The dropout rate was 11.4%. Compared to the e-HE group, the e-APA group did not have any effect on the HCP total volumes but increased the left subiculum volume. Also, the e-APA group significantly increased cardiorespiratory fitness (VO2max), improved lipidic profile and negative symptoms but not cognitive functions. This study demonstrated the high feasibility and multiple benefits of a remote e-APA program for SZPs. e-APA may increase brain plasticity and improve health outcomes in SZPs, supporting that PA should be an add-on therapeutic intervention. ClinicalTrial.gov on 25 august 2017 (NCT03261817).
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Affiliation(s)
- E Leroux
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France.
| | - M Tréhout
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
- Centre Esquirol, Service de Psychiatrie Adulte, CHU de Caen Normandie, 14000, Caen, France
| | - E Reboursiere
- Service de Médecine du Sport, CHU de Caen Normandie, 14000, Caen, France
| | - R de Flores
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
| | - R Morello
- Unité de Biostatistiques et Recherche Clinique, CHU de Caen Normandie, 14000, Caen, France
| | - O Guillin
- SHU du Rouvray, 76300, Sotteville-lès-Rouen, France
- Normandie Univ, UFR de Médecine, 76000, Rouen, France
- CHU de Rouen, 76000, Rouen, France
| | - G Quarck
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000, Caen, France
| | - S Dollfus
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
- Centre Esquirol, Service de Psychiatrie Adulte, CHU de Caen Normandie, 14000, Caen, France
- Université de Caen Normandie, Normandie Univ, UFR de Santé, 14000, Caen, France
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2
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Panassollo TRB, Lord S, Rashid U, Taylor D, Mawston G. The effect of chronotropic incompetence on physiologic responses during progressive exercise in people with Parkinson's disease. Eur J Appl Physiol 2024:10.1007/s00421-024-05492-5. [PMID: 38683403 DOI: 10.1007/s00421-024-05492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Heart rate (HR) response is likely to vary in people with Parkinson's disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription. METHODS Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO2), and changes in HR responses (HR/WR slope) to an increase in exercise demand. RESULTS CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively). CONCLUSION Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.
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Affiliation(s)
| | - Sue Lord
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, 6 Harrison Road, Mount Wellington, 1060, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Grant Mawston
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
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3
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Akinola PS, Tardif I, Leclerc J. Antipsychotic-Induced Metabolic Syndrome: A Review. Metab Syndr Relat Disord 2023; 21:294-305. [PMID: 37347965 DOI: 10.1089/met.2023.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipid abnormalities. Indeed, the risk of metabolic syndrome would be increased in the population with schizophrenia compared to the general population. The objective is to summarize the prevalence, the mechanisms, and the potential treatments of antipsychotic-induced metabolic syndrome. This is a narrative review of the literature. We searched the electronic database Medline, accessed through PubMed, to find studies that investigated the prevalence and treatments of metabolic syndrome in the adult population using antipsychotics. The prevalence of metabolic syndrome in patients treated with antipsychotics ranges from 37% to 63%. Antipsychotic iatrogenic effects include weight gain/increased waist circumference, dyslipidemia, insulin resistance/type 2 diabetes, and hypertension. Clozapine and olanzapine are reported to precipitate the onset of metabolic syndrome features. In patients with metabolic syndrome, an antipsychotic with less metabolic side effects such as lurasidone, lumateperone, ziprasidone, and aripiprazole should be prioritized. Unlike medications, aerobic exercise and dietetic counseling were found to be efficient as the nonpharmacologic treatment of antipsychotic-induced metabolic syndrome. Few pharmacological treatments were proven effective against weight gain in this patient population. The risk of metabolic syndrome induced by antipsychotics should be early recognized and closely monitored. Primary and secondary prevention of metabolic syndrome or onset of its feature might help reduce the risk of death for patients using antipsychotics.
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Affiliation(s)
- Pelumi Samuel Akinola
- College of Pharmacy, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jacinthe Leclerc
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Centre de Recherche, Institut Universitaire de Cardiologie de Pneumologie de Québec-Université Laval, Québec, Canada
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4
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Omar M, Wieben ES, Polcwiartek C, Fleischer J, Valentin JB, Aagaard J, Jensen SE, Nielsen RE. Cardiovascular autonomic neuropathy in patients with schizophrenia. Nord J Psychiatry 2021; 75:547-552. [PMID: 33825660 DOI: 10.1080/08039488.2021.1902566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is an independent predictor of cardiovascular disease (CVD) in patients with diabetes as well as in patients with pre-diabetes and metabolic syndrome. Patients with schizophrenia have an increased rate of metabolic syndrome, pre-diabetes and diabetes as compared to the general population. Despite of this, occurrence CAN has not been investigated in patient with schizophrenia. Therefore, the aims of this study were (1) to evaluate the feasibility testing for CAN with a new clinical tool and (2) report the prevalence of early and manifest CAN in patients with schizophrenia. METHODS AND RESULTS Patients with diagnosed schizophrenia and with a disease duration ≥10 years were matched 1:1 on age and gender at screening with psychiatric healthy controls. CAN was defined as ≥ two abnormal standard cardiovascular autonomic reflex tests (lying-to-standing, deep breathing, and Valsalva maneuver) using the VagusTM device. A total of 46 patients with schizophrenia were included and matched to psychiatric healthy controls. Manifest CAN were more frequently presented in patients with schizophrenia (39% vs. 6% for controls, p<.0001). Sensitivity analysis of 41 subjects with schizophrenia without diabetes matched to 41 psychiatric healthy controls, showed similar results (37% vs. 5% for controls, p<.0001). CONCLUSION CAN is highly prevalent in patients with schizophrenia. Testing for CAN is feasible and might be a new clinically tool for detecting early stages of CVD in patients with schizophrenia.
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Affiliation(s)
- Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Fleischer
- Steno Diabetes Center Aarhus and Steno Diabetes Center Zealand, Aarhus, Denmark
| | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University and Aalborg University Hospital, Aalborg, Denmark.,Department of Psychiatry, Aalborg University, Aalborg, Denmark
| | - Jørgen Aagaard
- Department of Psychiatry, Aalborg University, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University, Aalborg, Denmark
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Tréhout M, Leroux E, Bigot L, Jego S, Leconte P, Reboursière E, Morello R, Chapon PA, Herbinet A, Quarck G, Dollfus S. A web-based adapted physical activity program (e-APA) versus health education program (e-HE) in patients with schizophrenia and healthy volunteers: study protocol for a randomized controlled trial (PEPSY V@Si). Eur Arch Psychiatry Clin Neurosci 2021; 271:325-337. [PMID: 32458107 DOI: 10.1007/s00406-020-01140-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Patients with schizophrenia (SZ) have a high level of cardiovascular morbidity and some clinical symptoms of illness remain resistant to pharmacological approaches. A large number of studies support the effectiveness of physical activity (PA) in SZ. The aims of this trial is to assess the effects of a remote, web-based adapted PA program (e-APA) compared to a health education program (e-HE) on brain plasticity in SZ and healthy volunteers (HV) and on psychiatric, neurocognitive, circadian and physical variables. The study is an interventional, multicenter, randomized open-label trial. Forty-two SZ will be randomized to either the active group (e-APA, N = 21) or nonactive group (e-HE, N = 21), and 21 HV will be matched to SZ according to age, gender, and level of PA in both e-APA and e-HE groups. Interventions will consist of 32 sessions (2 × 60 min/week, for 16 weeks) via supervised home-based videoconferencing. Cerebral magnetic resonance imaging, psychiatric symptoms, neurocognitive and circadian rhythms assessments as well as physical tests and biological analyses will be assessed at baseline and 16 weeks after the intervention. To our knowledge, this is the first study aiming to evaluate the efficacy of APA delivered by supervised home-based videoconferencing in SZ. Moreover, using multimodal MRI, this study could clarify the pathophysiological mechanisms underlying the efficacy of APA. Finally, this innovative approach might also increase participation in long-term PA since PA-based programs are known to have low adherence and early dropout. Trial registration: ClinicalTrials.gov identifier: NCT03261817. Registered on 16 August 2017.
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Affiliation(s)
- Maxime Tréhout
- CHU de Caen Normandie, Service de Psychiatrie, Centre Esquirol, 14000, Caen, France
- Normandie Univ, UNICAEN, UFR de Médecine, 14000, Caen, France
- Normandie Univ, UNICAEN, ISTS EA 7466, GIP CYCERON, 14000, Caen, France
| | - Elise Leroux
- Normandie Univ, UNICAEN, ISTS EA 7466, GIP CYCERON, 14000, Caen, France
| | | | - Solenne Jego
- Normandie Univ, UNICAEN, ISTS EA 7466, GIP CYCERON, 14000, Caen, France
| | - Pascal Leconte
- Normandie Univ, UNICAEN/INSERM, UMR 1075, COMETE, PFRS, 14000, Caen, France
- Normandie Univ, UNICAEN, UFR STAPS, 14000, Caen, France
| | | | - Rémy Morello
- CHU de Caen Normandie, Unité de Biostatistiques et Recherche Clinique, 14000, Caen, France
| | | | | | - Gaëlle Quarck
- Normandie Univ, UNICAEN/INSERM, UMR 1075, COMETE, PFRS, 14000, Caen, France
- Normandie Univ, UNICAEN, UFR STAPS, 14000, Caen, France
| | - Sonia Dollfus
- CHU de Caen Normandie, Service de Psychiatrie, Centre Esquirol, 14000, Caen, France.
- Normandie Univ, UNICAEN, UFR de Médecine, 14000, Caen, France.
- Normandie Univ, UNICAEN, ISTS EA 7466, GIP CYCERON, 14000, Caen, France.
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6
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Andersen E, Bang-Kittilsen G, Bigseth TT, Egeland J, Holmen TL, Martinsen EW, Stensrud T, Engh JA. Effect of high-intensity interval training on cardiorespiratory fitness, physical activity and body composition in people with schizophrenia: a randomized controlled trial. BMC Psychiatry 2020; 20:425. [PMID: 32854688 PMCID: PMC7457274 DOI: 10.1186/s12888-020-02827-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Exercise may improve cardiorespiratory fitness in people with schizophrenia, however, possible condition-specific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group. The primary aim of this study, therefore, was to investigate the effect of high-intensity interval training on VO2max in people with schizophrenia. Second, we sought to determine whether the intervention would have an effect on general physical activity (PA) level and body composition. METHODS Eighty-two patients with schizophrenia were randomly assigned to supervised high-intensity interval training or computer gaming skills training, performed twice a week for 12 weeks. Oxygen uptake was measured directly, during a maximum exercise session on a treadmill. PA level were assessed using ActiGraph accelerometer, and body composition was assessed by bioelectrical impedance. Differences between groups were assessed by analysis of variance using a univariate general linear model. RESULTS There were no significant differences between the groups on any of the cardiorespiratory variables neither at baseline nor after the program. There were also no significant within-group differences in any of the cardiorespiratory fitness variables between the baseline and post-program time points, despite that 61% of the participants performing high-intensity interval training showed a significant increase in workload on the treadmill. However, 47% of the participants in the high-intensity interval training group had a ≥ 5% increase in VO2max. Participants supervised by mental health care providers with PA competence (e.g. rehabilitation center staff, sport scientist, physical trainer) had a much larger increase in VO2max compared to participants supervised by mental health workers without such competence, and when adding PA competence to the model, the intervention group increased VO2max significantly compared to the comparison group. The intervention had no significant effect on PA level or body composition. CONCLUSIONS The intervention did not improve VO2max, PA level or body composition but succeeded in increasing workload on the treadmill. With regard to VO2max, approximately half of the patients may be considered responders. TRIAL REGISTRATION ClinicalTrials.gov ; NCT02205684 , registered July 2014.
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Affiliation(s)
- Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, PO box 235, 3603, Kongsberg, Horten, Norway.
| | - Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Egil Wilhelm Martinsen
- Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
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7
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Howell S, Yarovova E, Khwanda A, Rosen SD. Cardiovascular effects of psychotic illnesses and antipsychotic therapy. Heart 2019; 105:1852-1859. [PMID: 31439658 DOI: 10.1136/heartjnl-2017-312107] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/21/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022] Open
Abstract
Mortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy. The pro-arrhythmic impact of traditional antipsychotics, especially via the hERG-potassium channel, has been known for several years. Newer antipsychotics have a reduced pro-arrhythmic profile but might contribute to higher cardiac death rates by worsening the metabolic profile. Clozapine-induced cardiomyopathy, which is dose independent, is a further concern and continuous monitoring of these patients is required. Prophylaxis with angiotensin-converting enzyme inhibitors is currently under review. Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.
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Affiliation(s)
- Sandra Howell
- Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UK
| | - Ekaterina Yarovova
- Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Ahmad Khwanda
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Stuart D Rosen
- Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UK .,Imperial College, National Heart and Lung Institute Division of Cardiovascular Sciences, London, UK
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8
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Herbsleb M, Keller-Varady K, Wobrock T, Hasan A, Schmitt A, Falkai P, Gabriel HHW, Bär KJ, Malchow B. The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia. Front Psychiatry 2019; 10:90. [PMID: 30918486 PMCID: PMC6424878 DOI: 10.3389/fpsyt.2019.00090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/07/2019] [Indexed: 12/22/2022] Open
Abstract
People with schizophrenia die on average 15-20 years earlier than age and gender matched controls in the general population. An essential part of this excess mortality in people with schizophrenia is caused by physical illnesses. Among the physical illnesses, cardiovascular disease (CVD) has been identified as the most common natural cause of death in up to 40-45% of the cases. Chronotropic incompetence (CI) is defined as the inability of the heart to increase its beating frequency in proportion to increased physical activity or higher metabolic demand. It is an established independent cardiovascular risk factor for major cardiac events and overall mortality and might explain adaptation intolerance of the cardiovascular system to even minor exercise courses. CI needs objective exercise testing for definitive diagnosis and therefore represents a biological marker indicating the integrity of the cardiovascular system. It was recently described in patients with schizophrenia and might help explain the reduced physical fitness in these patients and the inability of a subgroup of patients to benefit from exercise interventions. In this study, we tried to replicate the occurrence of CI in an independent sample of patients with schizophrenia and evaluated whether CI can be influenced by a continuous endurance training of 12 weeks. Therefore, we re-analyzed the fitness testing data of 43 patients with schizophrenia and 22 aged and gender matched healthy controls. Parameters of aerobic fitness and chronotropic response to exercise were calculated. Patients with schizophrenia were less physically fit than the healthy controls and displayed a significantly higher heart rate at rest. 10 of 43 patients with schizophrenia and no healthy control subject were classified as chronotropically incompetent. Chronotropic response to exercise did not change significantly after 12 weeks of continuous aerobic exercise training. No differences were observed for baseline heart rate and peak heart rate in both subgroups of schizophrenia patients. Aerobic fitness did not improve significantly in the patients with schizophrenia classified as chronotropically incompetent. Our results confirm the occurrence of CI in patients with multi-episode schizophrenia. This should be taken into account when planning an exercise or lifestyle intervention studies in this population. Schizophrenia patients with CI do not seem to benefit as well as schizophrenia patients without CI from aerobic exercise training interventions. Larger, prospective randomized controlled clinical trials with different training interventions are urgently needed to address the topic of schizophrenia patients not responding to exercise and the relationship to the illness itself.
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Affiliation(s)
- Marco Herbsleb
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Jena, Germany
| | | | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | | | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Berend Malchow
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
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9
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Herbsleb M, Schumann A, Lehmann L, Gabriel HHW, Bär KJ. Cardio-Respiratory Fitness and Autonomic Function in Patients with Major Depressive Disorder. Front Psychiatry 2019; 10:980. [PMID: 32116813 PMCID: PMC7011194 DOI: 10.3389/fpsyt.2019.00980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Patients with major depressive disorder (MDD) have an augmented risk of cardiovascular morbidity and mortality. Although a link between depression and autonomic dysfunction as well as reduced cardio-respiratory fitness (CRF) is well documented, the underlying cause is a matter of debate. Therefore, we studied the interplay between autonomic function, body composition and severity of the disease to disentangle possible physiological factors influencing the assumed lack of CRF in MDD patients. We investigated seventeen patients suffering from MDD and seventeen control subjects matched with respect to age, sex, body-mass-index, and smoking habits. A resting baseline assessment and a cardiopulmonary exercise test including a prolonged recovery period were performed to study autonomic function (i.e., heart rate responses and heart rate variability) during rest, exercise and recovery as well as CRF. Most investigated autonomic indices were significantly different at rest, during exercise as well as during recovery indicating altered autonomic modulation. Nevertheless, none of our participants was classified as chronotropically incompetent. As expected, a reduced CRF (i.e., peak oxygen uptake and peak power output, p < 0.01) was observed in patients compared to controls. In addition, a correlation of baseline heart rate and of heart rate during recovery with the ventilatory threshold 1 (p < 0.05) was found in patients only, indicating a relation to the lack of CRF. Furthermore, we observed a positive correlation of the severity of the disease with the weekly sitting time (p < 0.01) as well as a negative correlation with the activity time in the intensity domain walking (p < 0.001) and with the total score of the International Physical Activity Questionnaire (p < 0.01) for patients. This study shows that patients with MDD have altered autonomic function not only during resting conditions but also during exercise as well as recovery from exercise. Intervention studies are needed to evaluate how the described autonomic alterations can be influenced by increasing CRF due to appropriate exercise training programs.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany.,Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Luisa Lehmann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Holger H W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
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