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Nygård M, Brobakken MF, Lydersen S, Güzey IC, Morken G, Heggelund J, Wang E. Strength training integrated in long term collaborative care of patients with schizophrenia. Schizophr Res 2023; 260:67-75. [PMID: 37625226 DOI: 10.1016/j.schres.2023.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/26/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Skeletal muscle strength is reduced in patients with schizophrenia, contributing to their impaired physical health, functional performance, and potentially mental health challenges. Although short-term training programs have shown promising results, improving muscle strength and functional performance, it is unknown how exercise can be successfully integrated into the long-term clinical care of outpatients with schizophrenia. OBJECTIVE To investigate effects of strength training with adherence support in a collaborative care model. METHODS We randomized 28 men and 20 women (mean ± SD, 35 ± 11 years) to leg press maximal strength training (MST) with 4 sets at 90 % of one repetition maximum (1RM) 2 × week, facilitated by municipal service and professional supervision (TG), or a control group (CG). RESULTS The TG increased scaled leg press 1RM (0-3 months: 19 %; 0-6 months: 31 %, 0-12 months: 40 %, all p < .001, and 3-12 months: 18 %, p < .05) and power (0-3 months, 11 %; 0-6 months: 22 %, 0-12 months: 26 %, all p < .001, and 3-12 months: 13 %, p < .05) throughout the 1-year period compared to the CG. The increased muscle strength was accompanied by improved sit-to-stand performance (20 %) after 12 months (p < .001). Both groups also exhibited within-group improvements in walking work efficiency after 6 months (TG: 13 %; CG: 23 %) and 1 year (TG: 11 %; CG: 21 %, p < .01-0.05), but with no evident differences between the groups. Stair climbing performance remained unchanged. CONCLUSION Our results reveal that strength training can successfully be integrated as a part of long-term clinical care of outpatients with schizophrenia, contributing to improved functional performance.
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Affiliation(s)
- Mona Nygård
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Mathias Forsberg Brobakken
- Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jørn Heggelund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eivind Wang
- Department of Psychosis and Rehabilitation, Psychiatry Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Faculty of Health and Social Sciences, Molde University College, Molde, Norway
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2
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Berge J, Hjelmesæth J, Kolotkin RL, Støren Ø, Bratland-Sanda S, Hertel JK, Gjevestad E, Småstuen MC, Helgerud J, Bernklev T. Effect of aerobic exercise intensity on health-related quality of life in severe obesity: a randomized controlled trial. Health Qual Life Outcomes 2022; 20:34. [PMID: 35209911 PMCID: PMC8876087 DOI: 10.1186/s12955-022-01940-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background Aerobic exercise is an important part of obesity treatment and may improve health-related quality of life (HRQOL). The objective of this study was to compare the effect of two different exercise programs on health-related quality of life in patients with severe obesity. Methods This was a single-center, open-label, randomized, parallel-group study comparing the effects of a 24-week moderate-intensity continuous training (MICT) program and a combined high-intensity interval training program with MICT (HIIT/MICT). The primary objective (specified secondary outcome) was to assess HRQOL by using the general health dimension of the Short Form Health Survey (SF-36). The secondary objectives were to assess other dimensional SF-36 scores, the impact of weight on the physical and psychosocial aspects of quality of life (IWQOL-Lite), and the burden of obesity-specific weight symptoms (WRSM). Results 73 patients were enrolled and reported patient reported outcome measures, with 71 patients (55% females) allocated to either MICT (n = 34) or HIIT/MICT (n = 37). In the intention-to-treat analysis, general health scores increased between baseline and 24-week follow-up in both the HIIT/MICT group and the MICT group, with a mean change of 13 (95% CI 6–21) points and 11 (95% CI 5–17) points, respectively, with no difference between the groups. The effect sizes of these changes were moderate. The vitality and social functioning scores of SF-36, and the physical function and self-esteem scores of IWQOL-Lite increased moderately in both groups, with no difference between groups. The tiredness, back pain, and physical stamina scores based on WRSM showed moderate to strong changes in both the groups. Conclusions Patients who had completed a combined HIIT/MICT program did not experience larger improvements in general health compared with those completing a clean 24-week MICT program. Exercise may confer general health benefits independent of intensity. Trials registration Regional Committees for Medical and Health Research Ethics south east, Norway, October 23, 2013 (identifier: 2013/1849) and ClinicalTrials.gov December 8, 2014 (identifier: NCT02311738). Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01940-y.
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Affiliation(s)
- Jarle Berge
- Morbid Obesity Centre, Vestfold Hospital Trust, Box 2168, 3103, Tønsberg, Norway. .,Clinic of Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway. .,Nature, Health and Environment, University of South-Eastern Norway, Bø, Norway. .,Norwegian Police University College, Stavern, Norway.
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust, Box 2168, 3103, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ronette L Kolotkin
- Morbid Obesity Centre, Vestfold Hospital Trust, Box 2168, 3103, Tønsberg, Norway.,Quality of Life Consulting, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA.,Førde Hospital Trust, Førde, Norway
| | - Øyvind Støren
- Nature, Health and Environment, University of South-Eastern Norway, Bø, Norway.,Department of Sport, Physical Education and Outdoor Life Studies, University of South-Eastern Norway, Bø, Norway
| | - Solfrid Bratland-Sanda
- Department of Sport, Physical Education and Outdoor Life Studies, University of South-Eastern Norway, Bø, Norway
| | | | - Espen Gjevestad
- Clinic of Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.,Norwegian Police University College, Stavern, Norway
| | | | - Jan Helgerud
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.,Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway
| | - Tomm Bernklev
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,R&D Department, Vestfold Hospital Trust, Tønsberg, Norway
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3
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Melby K, Nygård M, Brobakken MF, Gråwe RW, Güzey IC, Reitan SK, Vedul-Kjelsås E, Heggelund J, Tchounwou PB. Test-Retest Reliability of the Patient Activation Measure-13 in Adults with Substance Use Disorders and Schizophrenia Spectrum Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1185. [PMID: 33572717 PMCID: PMC7908201 DOI: 10.3390/ijerph18031185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Patient Activation Measure-13 (PAM-13) is a valid and widely used questionnaire that assess an individual's knowledge, confidence, and skills for self-management of their chronic illness. Although there is some evidence regarding its reliability, the test-retest reliability has not been investigated among patients with substance use disorders (SUDs) or schizophrenia spectrum disorders. We investigated the internal consistency and test-retest reliability of PAM-13 in these populations. Test-retest reliability was analysed using data from 29 patients with SUDs and 28 with schizophrenia spectrum disorders. Cronbach's α and Intraclass Correlation Coefficient (ICC) scores were used to examine internal consistency and test-retest reliability, respectively. Of the 60 collected test-retest questionnaires, 57 were included in the analyses. No mean differences between time one (T1) and time two (T2) were observed in either patient group, except for item 12 in schizophrenia spectrum disorders patients (p < 0.05). Internal consistency for T1 and T2 was 0.75 and 0.84 in SUDs patients and 0.87 and 0.81 in schizophrenia spectrum disorders patients, respectively. The ICC was r = 0.86 in patients with SUDs and r = 0.93 in patients with schizophrenia spectrum disorders. To conclude, PAM-13 showed good internal consistency and test-retest reliability in SUDs and schizophrenia spectrum disorders patients.
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Affiliation(s)
- Katrine Melby
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway;
- Blue Cross Lade Addiction Treatment Centre, 7041 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Mona Nygård
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Mathias Forsberg Brobakken
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Rolf W. Gråwe
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Jørn Heggelund
- Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Paul B. Tchounwou
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Tiller Community Mental Health Centre, Division of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
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4
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Heggelund J, Vancampfort D, Tacchi MJ, Morken G, Scott J. Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta-analysis. Acta Psychiatr Scand 2020; 141:190-205. [PMID: 31646608 DOI: 10.1111/acps.13119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical staging models describe where an individual exists on a continuum from asymptomatic at-risk states (Stage 0) through to established late-stage disease (Stage 4). We applied this framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis. METHOD Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges' g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO2 in ml/kg/min). RESULTS Thirty-eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta-analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = -0.93; 95% CI -1.14, -0.71). Mean VO2 was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = -1.16; 95% CI -1.31, -1.03). CONCLUSIONS Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co-associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.
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Affiliation(s)
- J Heggelund
- Regional Centre for Healthcare Improvement, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - D Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,UPC KU Leuven, Leuven-Kortenberg, Belgium
| | - M J Tacchi
- Crisis Resolution and Home-Based Treatment Service, NTW NHS Trust, Newcastle, UK
| | - G Morken
- Department of Psychiatry, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Scott
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
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5
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Brobakken MF, Nygård M, Güzey IC, Morken G, Reitan SK, Heggelund J, Wang E, Vedul-Kjelsaas E. Aerobic interval training in standard treatment of out-patients with schizophrenia: a randomized controlled trial. Acta Psychiatr Scand 2019; 140:498-507. [PMID: 31565796 DOI: 10.1111/acps.13105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effects of integrating aerobic interval training (AIT) in standard care of out-patients with schizophrenia on aerobic capacity and conventional cardiovascular disease (CVD) risk factors. METHODS Out-patients with schizophrenia spectrum disorder were randomized to the following: 1) a training group (TG), performing AIT 2 day/week at the clinic with adherence support from municipal services; or 2) a control group (CG), given two AIT sessions and encouraged to exercise on their own. Feasibility was assessed through retention/adherence. V˙O2peak was measured directly along with conventional CVD risk factors before and after 12 weeks. RESULTS Of 48 out-patients, 16/25 and 18/23 completed the TG and CG respectively. After 12 weeks, V˙O2peak was higher (2.7 ± 4.8 ml/kg/min, P < 0.01) in the TG compared with the CG. The TG improved V˙O2peak by 3.1 ± 3.7 ml/kg/min (P < 0.01), while no change in the CG was observed. No intergroup difference in weight, body mass index (BMI), waist circumference, blood pressure, lipids, or glucose at posttest was observed. Weight (1.9 ± 4.0 kg, P < 0.05) and BMI (0.5 ± 1.1 kg/m2 , P < 0.05) increased in the CG, with no change in the TG. CONCLUSION AIT, combined with adherence support, of out-patients with schizophrenia was feasible, improved V˙O2peak , and may be integrated in standard care. (ClinicalTrials.gov identifier: NCT02743143).
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Affiliation(s)
- M F Brobakken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Nygård
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - I C Güzey
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - G Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - S K Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - J Heggelund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Wang
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - E Vedul-Kjelsaas
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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6
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Holmen TL, Engh JA, Andersen E, Andreassen OA, Martinsen EW, Bigseth TT, Bang-Kittilsen G, Egeland J. Cardio-respiratory fitness is associated with a verbal factor across cognitive domains in schizophrenia. Schizophr Res 2019; 206:157-162. [PMID: 30528313 DOI: 10.1016/j.schres.2018.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/22/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated whether the relationship between cardio-respiratory fitness (CRF) and cognition in schizophrenia is general, or due to selective relationships between CRF and specific aspects of cognitive function. METHOD Eighty outpatients with schizophrenia spectrum disorders participated. Neurocognition was assessed with the Wechsler Adult Intelligence Scale version 4 General Ability Index (WAIS GAI), the MATRICS Consensus Cognitive Battery (MCCB) and the Emotion in Biological Motion (EBM) test. CRF was assessed with peak oxygen uptake measured directly during maximum exercise using a modified Balke protocol. Partial correlations, controlling for sex and age, were obtained for the perceptual and the verbal indices of WAIS GAI, six cognitive domains of MCCB, and the EBM total score. A factor analysis was conducted on all 15 subtests of the WAIS GAI and the MCCB, and the factors were subjected to separate regression analyses with CRF as predictor. RESULTS Significant, moderately sized correlations were found between CRF and all cognitive domains except processing speed. The correlation appeared strongest for CRF and the Verbal Comprehension Index of WAIS GAI (r = 0.29, p = .005). The factor analysis identified three factors: one speed/attention/executive function factor, one verbal factor, and one perceptual factor. Regression analyses showed that VO2peak explained a significant amount of variance in the verbal factor only (R2 = 0.06, β = 0.329, p = .03). CONCLUSION The results indicate that the relationship between CRF and cognition in schizophrenia is selectively tied to a modality-specific association with verbal cognitive abilities. These findings have implications for understanding the relation between cognitive factors and physical health in schizophrenia. ClinicalTrials.gov reg. number NCT02205684 (clinicaltrials.gov/ct2/show/NCT02205684).
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Affiliation(s)
- Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University College of Southeast Norway, Norway
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Wilhelm Martinsen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, 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
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7
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Brobakken MF, Nygård M, Taylor JL, Güzey IC, Morken G, Reitan SK, Heggelund J, Vedul-Kjelsaas E, Wang E. A comprehensive cardiovascular disease risk profile in patients with schizophrenia. Scand J Med Sci Sports 2019; 29:575-585. [DOI: 10.1111/sms.13371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Mathias Forsberg Brobakken
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Østmarka, Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Mona Nygård
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Østmarka, Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Joshua Landen Taylor
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Research and Development; Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Østmarka, Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Solveig Klaebo Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Research and Development; Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Jørn Heggelund
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Østmarka, Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Einar Vedul-Kjelsaas
- Department of Mental Health, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Research and Development; Division of Mental Health Care; St. Olavs University Hospital; Trondheim Norway
| | - Eivind Wang
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Faculty of Health and Social Sciences; Molde University College; Molde Norway
- Department of Internal Medicine; University of Utah; Salt Lake City, Utah
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8
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Holmen TL, Egeland J, Andersen E, Mordal J, Andreassen OA, Ueland T, Bigseth TT, Bang-Kittilsen G, Engh JA. The Association Between Cardiorespiratory Fitness and Cognition Appears Neither Related to Current Physical Activity Nor Mediated by Brain-Derived Neurotrophic Factor in a Sample of Outpatients With Schizophrenia. Front Psychiatry 2019; 10:785. [PMID: 31708824 PMCID: PMC6823665 DOI: 10.3389/fpsyt.2019.00785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: We investigated whether levels of current physical activity (PA) contribute to the established relationship between cardiorespiratory fitness (CRF) and cognition in schizophrenia and whether brain-derived neurotrophic factor (BDNF) or its precursor proBDNF mediates this relationship. Method: Sixty-one outpatients with schizophrenia spectrum disorders participated. Neurocognition was assessed with the Wechsler Adult Intelligence Scale (WAIS) and nine subtests from the MATRICS battery comprising a neurocognitive composite score (NCS). CRF was assessed with peak oxygen uptake (VO2peak) measured directly during a maximum exercise test. Current PA levels were objectively assessed by an accelerometer worn for four consecutive days. BDNF and proBDNF were measured in fasting blood. Four serial parallel mediation analyses and two additional parallel mediation analyses were conducted, while controlling for age and sex at all levels. Results: No direct effects were found between PA measures and WAIS or NCS. No significant mediating effects of CRF or BDNF/proBDNF were detected. Conclusion: The results do not support the hypothesis that PA contributes to the naturally occurring relationship between CRF and cognition in schizophrenia or the hypothesis that BDNF or proBDNF mediates this relationship. The results arguably support the assumption that the association between CRF and cognition in schizophrenia is established developmentally early. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02205684.
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Affiliation(s)
- Tom Langerud Holmen
- 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
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University College of Southeast Norway, Notodden, Norway
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ole Andreas Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,KG Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
| | | | - Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
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9
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Holmen TL, Egeland J, Andersen E, Bigseth TT, Engh JA. The association between cardio-respiratory fitness and cognition in schizophrenia. Schizophr Res 2018; 193:418-422. [PMID: 28709774 DOI: 10.1016/j.schres.2017.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Schizophrenia is associated with reduced cardio-respiratory fitness (CRF), and impaired cognition is a core feature of the disorder. Despite their particular significance to schizophrenia disparately, the relationship between these two variables has not yet been thoroughly assessed. In this study we aimed to investigate naturally occurring associations between CRF and all cognitive domains within this patient population. METHOD Eighty outpatients with schizophrenia spectrum disorders participated in the study. Neurocognition was assessed with the Wechsler Adult Intelligence Scale version 4 General Ability Index (WAIS GAI) and the MATRICS Consensus Cognitive Battery (MCCB). Oxygen uptake was measured directly by analyzing O2 and CO2 content in expired air during a maximum exercise session on a treadmill using a modified Balke protocol. Clinical symptom load was assessed with the Positive and Negative Syndrome Scale (PANSS). Hierarchical multiple regression analyses were conducted, controlling for sex and age, and negative psychotic symptom levels. RESULTS CRF explained a significant 8.2% and 9.1% of the variance in general intellectual ability and state-sensitive cognitive functioning respectively, beyond the impact of negative psychotic symptom load. CONCLUSION The study indicates a direct relation between CRF and cognition in schizophrenia. Impaired cognition is a difficult-to-treat expression of the disorder, and identifying modifiable factors possibly mediating cognition, such as CRF, is of great clinical value.
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Affiliation(s)
- Tom Langerud Holmen
- 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
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University College of Southeast, Norway
| | | | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
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10
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Jerome GJ, Young DR, Dalcin AT, Wang NY, Gennusa J, Goldsholl S, Appel LJ, Daumit GL. Cardiorespiratory benefits of group exercise among adults with serious mental illness. Psychiatry Res 2017; 256:85-87. [PMID: 28624677 PMCID: PMC5603397 DOI: 10.1016/j.psychres.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/04/2017] [Accepted: 06/09/2017] [Indexed: 11/27/2022]
Abstract
This study examined cardiorespiratory fitness (CRF) among adults with serious mental illness (SMI) participating in group exercise classes. Overweight and obese adults with SMI were randomized to either a control condition or a weight management condition with group exercise classes (n = 222). Submaximal bicycle ergometry was used to assess CRF at baseline, 6 and 18 months. Those with ≥ 66% participation in the exercise classes had a lower heart rate response at 6 and 18 month follow-up. Participation in group exercise classes was associated with improved short and long term cardiovascular fitness among adults with SMI.
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University Towson, 8000 York Road, Towson, MD 21252, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Deborah Rohm Young
- Kaiser Permanente Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lawrence J Appel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
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11
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Engh JA, Andersen E, Holmen TL, Martinsen EW, Mordal J, Morken G, Egeland J. Effects of high-intensity aerobic exercise on psychotic symptoms and neurocognition in outpatients with schizophrenia: study protocol for a randomized controlled trial. Trials 2015; 16:557. [PMID: 26646670 PMCID: PMC4672547 DOI: 10.1186/s13063-015-1094-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
Background The focus in recent years on physical inactivity and metabolic disturbances in individuals with schizophrenia raises the question of potential effects of physical activity. Physical activity has shown beneficial effects on cognition in healthy older individuals as well as on symptom severity in depression. However, opinions diverge regarding whether aerobic high-intensity interval training reduces cognition and key symptoms in schizophrenia. The main objective for the trial is to investigate the potential effects of aerobic high-intensity interval training on neurocognitive function and mental symptoms in outpatients with schizophrenia. Methods/Design The trial is designed as a randomized controlled, observer-blinded clinical trial. Patients are randomized to 1 of 2 treatment arms with 12-week duration: aerobic high-intensity interval training or computer gaming skills training. All participants also receive treatment as usual. Primary outcome measure is neurocognitive function. Secondary outcome measures will be positive and negative symptoms, wellbeing, tobacco-smoking patterns and physiological/metabolic parameters. Patient recruitment takes place in catchment area-based outpatient clinics. Trial registration ClinicalTrials.gov NCT02205684. Registered 29 July 2014.
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Affiliation(s)
- John A Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Eivind Andersen
- Faculty of Humanities and Education, Department of Practical, Physical and Aesthetic Education, Buskerud and Vestfold University College, Borre, Norway.
| | - Tom L Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Egil W Martinsen
- Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Gunnar Morken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Psychology, University of Oslo, Oslo, Norway.
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12
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Prefrontal and Hippocampal Brain Volume Deficits: Role of Low Physical Activity on Brain Plasticity in First-Episode Schizophrenia Patients. J Int Neuropsychol Soc 2015; 21:868-79. [PMID: 26581798 PMCID: PMC4654705 DOI: 10.1017/s1355617715000983] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Our objective in the present study was to conduct the first empirical study of the effects of regular physical activity habits and their relationship with brain volume and cortical thickness in patients in the early phase of schizophrenia. Relationships between larger brain volumes and higher physical activity levels have been reported in samples of healthy and aging populations, but have never been explored in first-episode schizophrenia patients. METHOD We collected MRI structural scans in 14 first-episode schizophrenia patients with either self-reported low or high physical activity levels. We found a reduction in total gray matter volume, prefrontal cortex (PFC), and hippocampal gray matter volumes in the low physical activity group compared to the high activity group. Cortical thickness in the dorsolateral and orbitofrontal PFC were also significantly reduced in the low physical activity group compared to the high activity group. In the combined sample, greater overall physical activity levels showed a non-significant tendency with better performance on tests of verbal memory and social cognition. Together these pilot study findings suggest that greater amounts of physical activity may have a positive influence on brain health and cognition in first-episode schizophrenia patients and support the implementation of physical exercise interventions in this patient population to improve brain plasticity and cognitive functioning.
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13
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Abstract
Treatment resistance, along with its sibling partial response, remains a common phenomenon in schizophrenia, complicating the disability burden inherent in the disease. Antipsychotic medications are the mainstay of treatment, and treatment resistance has mainly been defined in terms of poor response to antipsychotic medication. At the same time, clozapine, the most effective antipsychotic, remains underutilized at the expense of exposing patients to polypharmacy. We review known causes of disability in schizophrenia, how they impact various areas of everyday functioning, and discuss potential treatment options including but not limited to pharmacological approaches aimed at maximizing treatment response and reducing treatment resistance.
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14
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Heggelund J, Kleppe KD, Morken G, Vedul-Kjelsås E. High aerobic intensity training and psychological States in patients with depression or schizophrenia. Front Psychiatry 2014; 5:148. [PMID: 25400592 PMCID: PMC4214195 DOI: 10.3389/fpsyt.2014.00148] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/11/2014] [Indexed: 11/13/2022] Open
Abstract
AIM To explore changes in psychological states in response to a bout of high aerobic intensity training (HIT) in patients with depression or schizophrenia compared to healthy individuals. METHODS After familiarization training of HIT, 20 patients with schizophrenia, 13 patients with depression, and 20 healthy individuals performed a no-training day followed by a training day. HIT was 4 × 4 min intervals at 85-95% of peak heart rate, intermitted by 3 min active rest periods at 70% of peak heart rate. Self-evaluation questionnaires of positive affect, negative affect, state anxiety, well-being, distress, and fatigue were completed before training, 15 min after, and 3 h after training. The two latter measures were also completed the no-training day. RESULTS All three groups improved in positive affect and well-being 15 min after HIT (p < 0.01), but only patients with depression had maintained the effect after 3 h (p = 0.007, p = 0.012). The duration of the improved positive affect was longer in depression (p = 0.002) and schizophrenia (p = 0.025) than in healthy individuals (F 2.50 = 5.83, p < 0.01). Patients with depression or schizophrenia had reduced distress and state anxiety 15 min after HIT and 3 h after HIT (p < 0.05). The improvement in distress 15 min after HIT was larger in patients with depression (p = 0.028) compared to healthy individuals (F 2.50 = 5.05, p < 0.01). No changes were found during the no-training day (p > 0.05). CONCLUSION High aerobic intensity training used as an acute intervention improved positive affect and well-being and reduced distress and state anxiety in patients with depression and schizophrenia. ClinicalTrials.gov identifier: NCT01310998.
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Affiliation(s)
- Jørn Heggelund
- Division of Psychiatry, Department of Østmarka, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kim Daniel Kleppe
- Hamar District Psychiatric Centre, Innlandet Hospital Trust, Ottestad, Norway
| | - Gunnar Morken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, Department of Research and Development (AFFU), St. Olavs University Hospital, Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, Department of Research and Development (AFFU), St. Olavs University Hospital, Trondheim, Norway
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15
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Bernard P, Romain AJ, Vancampfort D, Baillot A, Esseul E, Ninot G. Six minutes walk test for individuals with schizophrenia. Disabil Rehabil 2014; 37:921-7. [DOI: 10.3109/09638288.2014.948136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Holmemo HDQ, Fløvig JC, Heggelund J, Vedul-Kjelsås E. Differences in Aerobic Fitness between Inpatients and Outpatients with Severe Mental Disorders. Front Psychiatry 2014; 5:95. [PMID: 25140156 PMCID: PMC4121529 DOI: 10.3389/fpsyt.2014.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with severe mental disorders have increased mortality, and cardiovascular disease (CVD) accounts for a large part. Physical inactivity and low aerobic fitness have been recognized as significant risk factors for CVD. In this study, we investigated the differences in aerobic fitness and physical activity between in- and outpatients with severe mental disorders. METHOD AND SUBJECTS Fifty in- and outpatients from a regional psychiatric department were included. The patients filled in a questionnaire on physical activity and completed a clinical examination. An estimation of aerobic fitness was calculated for each patient, using gender, age, waist circumference, resting heart rate, and physical activity level as variables. RESULTS Inpatients had lower estimated aerobic fitness than outpatients (VO2peak 42 vs. 50 mL kg(-1) min(-1), p < 0.001). Compared to population data matched for age and gender, inpatients had lower aerobic fitness, while outpatients were not different from the population average. CONCLUSION Inpatients at a psychiatric department had lower estimated aerobic fitness than outpatients, and a lower aerobic fitness compared to the general population. Our findings suggest that inpatients with severe mental disorders should be considered a high risk group for CVD.
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Affiliation(s)
| | - John Christian Fløvig
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway ; Division of Psychiatry, Department of Østmarka, St. Olavs University Hospital , Trondheim , Norway
| | - Jørn Heggelund
- Division of Psychiatry, Department of Østmarka, St. Olavs University Hospital , Trondheim , Norway
| | - Einar Vedul-Kjelsås
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway ; Department of Research and Development (AFFU), Division of Psychiatry, St. Olavs University Hospital , Trondheim , Norway
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17
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Herbsleb M, Mühlhaus T, Bär KJ. Differential cardiac effects of aerobic interval training versus moderate continuous training in a patient with schizophrenia: a case report. Front Psychiatry 2014; 5:119. [PMID: 25221528 PMCID: PMC4148625 DOI: 10.3389/fpsyt.2014.00119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/14/2014] [Indexed: 12/24/2022] Open
Abstract
Increased cardiovascular morbidity and mortality rates for patients with schizophrenia are reported to contribute to their reduced life expectancy. Common reasons for increased cardiac mortality rates include cigarette smoking, obesity, dyslipidemia, diabetes, and poorer health behavior in general. The majority of excess mortality among people with schizophrenia is caused by cardiovascular complications. Reduced vagal activity might be one important mechanism leading to this increased cardiac mortality and has been consistently described in patients and their healthy first-degree relatives. In this case study, we compared two different aerobic exercise regimes in one patient with chronic schizophrenia to investigate their effects on cardiovascular regulation. The patient completed a 6-week period of moderate continuous training (CT) followed by a 6-week period of interval training (IT), each regime two times per week, on a stationary bicycle. This was followed by a 6-week period of detraining. Primary outcome measures examined heart rate (HR) and heart rate variability (HRV) at rest while secondary measures assessed fitness parameters such as the ventilatory threshold 1 (VT1). We observed that IT was far more effective than moderate CT in increasing HRV, as indicated by root mean of squared successive difference (improvement to baseline 27 versus 18%), and reducing resting HR (-14 versus 0%). Improvement in VT1 (21 versus -1%) was only observed after IT. Our study provides preliminary data that the type of intervention is highly influential for improving cardiac function in patients with schizophrenia. While cardiovascular function might be influenced by CT to some degree, no such effect was present in this patient with schizophrenia. In addition, the beneficial effect of IT on HR regulation vanished completely after a very short period of detraining after the intervention.
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Affiliation(s)
- Marco Herbsleb
- Pain and Autonomic Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, University Hospital Jena , Jena , Germany ; Clinical Exercise Physiology (CEP), Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University , Jena , Germany
| | - Tobias Mühlhaus
- Pain and Autonomic Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, University Hospital Jena , Jena , Germany
| | - Karl-Jürgen Bär
- Pain and Autonomic Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, University Hospital Jena , Jena , Germany
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18
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Scheewe TW, Backx FJG, Takken T, Jörg F, van Strater ACP, Kroes AG, Kahn RS, Cahn W. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand 2013; 127:464-73. [PMID: 23106093 DOI: 10.1111/acps.12029] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this multicenter randomised clinical trial was to examine the effect of exercise versus occupational therapy on mental and physical health in schizophrenia patients. METHOD Sixty-three patients with schizophrenia were randomly assigned to 2 h of structured exercise (n = 31) or occupational therapy (n = 32) weekly for 6 months. Symptoms (Positive and Negative Syndrome Scale) and cardiovascular fitness levels (Wpeak and VO2peak ), as assessed with a cardiopulmonary exercise test, were the primary outcome measures. Secondary outcome measures were the Montgomery and Åsberg Depression Rating Scale, Camberwell Assessment of Needs, body mass index, body fat percentage, and metabolic syndrome (MetS). RESULTS Intention-to-treat analyses showed exercise therapy had a trend-level effect on depressive symptoms (P = 0.07) and a significant effect on cardiovascular fitness, measured by Wpeak (P < 0.01), compared with occupational therapy. Per protocol analyses showed that exercise therapy reduced symptoms of schizophrenia (P = 0.001), depression (P = 0.012), need of care (P = 0.050), and increased cardiovascular fitness (P < 0.001) compared with occupational therapy. No effect for MetS (factors) was found except a trend reduction in triglycerides (P = 0.08). CONCLUSION Exercise therapy, when performed once to twice a week, improved mental health and cardiovascular fitness and reduced need of care in patients with schizophrenia.
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Affiliation(s)
- T W Scheewe
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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SCHEEWE THOMASW, TAKKEN TIM, KAHN RENÉS, CAHN WIEPKE, BACKX FRANKJG. Effects of Exercise Therapy on Cardiorespiratory Fitness in Patients with Schizophrenia. Med Sci Sports Exerc 2012; 44:1834-42. [DOI: 10.1249/mss.0b013e318258e120] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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