The Dutch 'Focus on Strength' intervention study protocol: programme design and production, implementation and evaluation plan

Interventions to prevent obesity in children aged 12 to 18 years old

BACKGROUND

Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review.

OBJECTIVES

To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was February 2023.

SELECTION CRITERIA

Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect.

AUTHORS' CONCLUSIONS

The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.

School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis

OBJECTIVE

Many school-based intervention studies are conducted to increase students' physical activity (PA). Recruitment and retention problems potentially impact the robustness of RCT findings. We conducted a meta-analysis to summarize recruitment and retention rates in long-term secondary school-based PA intervention studies and examined associated participant and intervention characteristics.

METHODS

Web of Science, Pubmed, Medline, and PsychInfo were searched until March 20th 2023. We included studies on secondary school-based PA interventions ≥12 weeks, aimed at typically developing adolescents. We abstracted number of schools and students invited, randomized, and participating at follow-up to calculate pooled recruitment and retention rates; participant and intervention characteristics were abstracted to execute subgroup or meta-regression analyses.

RESULTS

Recruitment rates were 51% for invited schools and 80% for invited students, the retention for schools was almost 100% and for students 91%. Interventions with fixed and flexible components, executed in Asia and South America, and from later publication years had higher student recruitment rates. Students' retention rates were lower for interventions which had flexible components, were theory/model-based, used an accelerometer, had a longer intervention duration, and included more females.

CONCLUSION

Recruitment and retention rates in school-based PA interventions are high. Some participant and intervention characteristics influence these rates: flexibility of the intervention, theory/model-based intervention, accelerometer use, intervention duration, continent, and number of females. Researchers should consider these characteristics in intervention development to achieve optimal balance between intervention effectiveness, recruitment, and retention.

The Let's Eat Healthy and Move at School program for adolescents in South Korea: Program design, implementation, and evaluation plan using intervention mapping

Purpose

This study aimed to systematically develop an obesity prevention program for adolescents to promote healthy eating and physical activity in schools.

Methods

The development of the Let's Eat Healthy and Move at School program for adolescents followed the six steps of intervention mapping (IM). IM is a widely used protocol for developing systematic and effective interventions based on theories and evidence.

Results

To better understand the problem and identify the needs of adolescents, interviews were conducted with teachers, school nurses, and students (step 1). In step 2, the desired behaviors and their determinants were established and combined into a matrix comprising 16 change objectives. In step 3, theoretical methods such as persuasive communication and consciousness-raising were chosen. The program was segmented into three educational activity sessions in step 4. In step 5, an implementation manual was developed for program instructors to ensure effective and accurate implementation. Finally, practices for evaluating the program's effectiveness and procedures were designed in step 6.

Conclusion

The Let’s Eat Healthy and Move at School program will provide adolescents with guidelines to promote healthy living and prevent obesity in everyday life using strategies for sustainable adolescent obesity prevention and management.

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

OBJECTIVES

People with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We aimed to systematically develop a theoretically informed intervention that would enable PwPMS to more readily engage in regular physical activity.

DESIGN

We used an intervention mapping approach to inform intervention development.

SETTING

We conducted semistructured interviews with PwPMS and their families/carers and physiotherapists recruited from secondary care settings.

PARTICIPANTS

Fourteen PwPMS with an Expanded Disability Status Scale score of between 6 and 8 and 7 of their families/carers and 13 physiotherapists and 1 physiotherapy technician participated.

RESULTS

Interview data suggested that the development of supportive coaching relationships with physiotherapists could promote the ability of PwPMS to achieve a desirable and achievable physical activity plan. These interview data informed the prototype 'Lifestyle Exercise and Activity Package for Multiple Sclerosis' (LEAP-MS) consisting of a secure multiuser web-based platform (with an education and activity suite, interactive components enabling selection of exercises, goal setting and activity logging), up to six flexible face-to-face or web-based physiotherapy coaching sessions and remote support via an embedded web-based messaging function that all together draw on specific theory-based methods to achieve physical activity behaviour change, namely active learning, reinforcement, modelling, feedback, facilitation, goal setting and guided practice. Implementation is within a multiuser platform accessible to participants, trained physiotherapists and researchers.

CONCLUSIONS

We have followed an inclusive, systematic and transparent process to develop the LEAP-MS intervention that enables detailed description of components, context and guiding principles to inform ongoing evaluation. Importantly, PwPMS expressed the need for autonomy in developing physical activity plans. This has been achieved through the embedding of self-management principles in the design and delivery of the LEAP-MS intervention.

How aware are swingers about their swing sex partners' risk behaviours, and sexually transmitted infection status?

Background

Swingers are members of a heterosexual couple who, as a couple, have sex with others. They constitute a hidden subpopulation that is at risk for sexually transmitted infections (STIs). This study aimed to determine swingers’ level of awareness about the STI risk (indicators: bisexual behaviour, number of sex partners, and STI status) of their swing sex partners (i.e. alters).

Methods

In this cross-sectional study, data were collected from a convenience sample of swingers who visited our STI clinic. The sample consisted of 70 participants (i.e. egos) and their 299 swing sex partners (i.e. alters) who had undergone an STI test at our clinic. We compared network data (i.e. information that egos provided about alters) and data stored in the electronic patient record (EPR) in our clinic (i.e. information provided by alters themselves). We assessed the agreement (correct estimation, overestimation and underestimation) between the network data and EPR data using chi-squared tests.

Results

Egos underestimated the bisexual behaviours of 37% of their male alters and overestimated the number of sex partners of 54 and 68% of their male and female alters, respectively. Egos correctly estimated the STI statuses of only 22% of the alters who had an STI during the past six months.

Conclusions

The participating swingers underestimated the bisexual behaviours of their male swing sex partners, overestimated their number of sex partners, and underestimated their positive STI status. Underestimating their alters’ STI statuses can cause swingers to underestimate their own STI risk and fail to implement preventive measures. The latter finding has implications for STI prevention. Therefore, more attention should be paid to swingers in general and the promotion of actual partner notification and STI testing among swingers in specific.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-05813-5.

Bidirectional Day-to-Day Associations of Reported Sleep Duration With Accelerometer Measured Physical Activity and Sedentary Time Among Dutch Adolescents: An Observational Study

Objectives

To examine the bidirectional association of sleep duration with proportions of time spent in physical behaviors among Dutch adolescents.

Methods

Adolescents (n = 294, 11-15 years) completed sleep diaries and wore an accelerometer (ActiGraph) over 1 week. With linear mixed-effects models, the authors estimated the association of sleep categories (short, optimal, and long) with the following day's proportion in physical behaviors. With generalized linear mixed models with binomial distribution, the authors estimated the association of physical behavior proportions on sleep categories. Physical behavior proportions were operationalized using percentages of wearing time and by applying a compositional approach. All analyses were stratified by gender accounting for differing developmental stages.

Results

For males (number of observed days: 345, n = 83), short as compared with optimal sleep was associated with the following day's proportion spent in sedentary (-2.57%, p = .03, 95% confidence interval [CI] [-4.95, -0.19]) and light-intensity activities (1.96%, p = .02, 95% CI [0.27, 3.65]), which was not significant in the compositional approach models. Among females (number of observed days: 427, n = 104), long sleep was associated with the proportions spent in moderate- to vigorous-intensity physical activity (1.69%, p < .001, 95% CI [0.75, 2.64]) and in sedentary behavior (-3.02%, p < .01, 95% CI [-5.09, -0.96]), which was replicated by the compositional approach models. None of the associations between daytime activity and sleep were significant (number of obs.: 844, n = 204).

Conclusions

Results indicate partial associations between sleep and the following day's physical behaviors, and no associations between physical behaviors and the following night's sleep.

Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis

BACKGROUND

It has been reported that boys' and girls' physical activity (PA) levels decline throughout adolescence. Boys are at risk of physical inactivity during adolescence; however, in intervention research, they are an under-represented group relative to girls. It is suggested that the school environment may be central to developing interventions that support adolescents in meeting the current PA guidelines. The aim of this systematic review and meta-analysis was to investigate the efficacy of school-based physical activity interventions for improving muscular fitness (MF) in adolescent males.

METHODS

This systematic review and meta-analysis followed the preferred reporting systems for meta-analyses guidelines and was registered on PROSPERO (Registration number: CRD42018091023). Eligible studies were published in English within peer-reviewed articles. Searches were conducted in three databases, with an additional grey literature search in Google Scholar. Studies investigating MF outcomes were included.

RESULTS

There were 43 data sets identified across 11 studies, from seven countries. Overall methodological quality of the studies was moderate-to-strong. Interventions targeting MF evidenced a small-to-medium effect (g = 0.32, CI 0.17, 0.48, p < 0.00). Subgroup analyses of MF delivery method resulted in small-to-medium effects: upper limb MF measures (g = 0.28, 95% CI - 0.02, 0.58, p = 0.07), lower limb MF measures (g = 0.28, 95% CI 0.09, 0.68, p = 0.03), combined MF activities (g = 0.24, 95% CI - 0.04 to 0.49, p = 0.05), plyometric activities (g = 0.39, 95% CI 0.09, 0.68, p = 0.01), body weight (g = 0.27, 95% CI - 0.10, 0.65, p = 0.15), and traditional MF methods (g = 0.43, 95% CI 0.09, 0.78, p = 0.01).

CONCLUSIONS

School-based interventions which aimed to increase MF outcomes in adolescent boys demonstrated small-to-moderate effects. Traditional and plyometric methods of resistance training appear to be the most effective form of PA delivery in adolescent males. More quality research is required to assess the impact of MF delivered in the school environment to inform future intervention design.

Strength exercises during physical education classes in secondary schools improve body composition: a cluster randomized controlled trial

BACKGROUND

Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity.

METHODS

A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome.

RESULTS

After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (intervention

CONCLUSION

In 11-15 year olds, the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level. TRIAL REGISTRATION ID: ( NTR5676 - retrospectively registered 8 February 2016; enrolment of first participant: 2 March 2015).

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Key Words

• Body composition
• Cluster randomised controlled trial
• Motivation
• Overweight and obesity
• Physical activity
• School-based
• Strength exercises

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MESH Headings

• Adolescent
• Adolescent Behavior
• Body Composition
• Child
• Cluster Analysis
• Curriculum
• Female
• Humans
• Male
• Motivation
• Muscle Strength
• Netherlands
• Obesity/prevention & control
• Physical Education and Training/methods
• Program Evaluation/methods
• Retrospective Studies
• School Health Services
• Schools
• Students

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Grants

• 525001004 ZonMw

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Affiliation(s)

G. A. Ten Hoor Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
G. M. Rutten Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
G. J. P. Van Breukelen Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
G. Kok Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
R. A. C. Ruiter Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
K Meijer Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
S. P. J. Kremers Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
F. J. M. Feron Department of Social Medicine, CAPHRI, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
R. Crutzen Department of Health Promotion, CAPHRI, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
A. M. J. W. Schols Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
G. Plasqui Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200 MD Maastricht, The Netherlands

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A Benefit of Being Heavier Is Being Strong: a Cross-Sectional Study in Young Adults

Background

In this study, the main hypothesis is that heavier people enjoy strength exercises more than normal-weight people, mediated by fat-free mass and muscle strength. Further, it is hypothesized that heavier people are better in strength exercises and enjoy strength exercises more compared to aerobic exercises.

Methods

In a cross-sectional study, height, weight, body composition (i.e., fat mass and fat-free mass by underwater weighing), muscle strength (i.e., one-repetition maximal strength for the leg press and chest press), maximal aerobic exertion (VO₂max) during cycle ergometry, and psychological determinants (i.e., attitudes, intentions, and self-determined motivations for strength exercises and aerobic exercises using questionnaires) were measured in 68 participants (18–30 years).

Results

Significant correlations between weight/BMI and fat-free mass (index) (r values = .70–.80, p values < .001), fat-free mass and muscle strength (r values = .35–.55, p values < .05), and muscle strength and attitudes, intentions, and motivation for strength exercises were found (r values = .29–.43, p values < .05); BMI was related to psychological determinants via fat-free mass and muscle strength. Furthermore, participants with a higher BMI are significantly better in strength exercises, more intrinsically motivated, and less motivated to do strength exercises compared to aerobic exercises (all p values < .05). Trends in the same direction were found for the following variables: instrumental attitude, experiential attitude, and intention (p values < .1).

Conclusions

Strength exercises could be more appropriate for heavier people and might therefore be a valuable component in physical activity programs for people who are overweight or obese.

Electronic supplementary material

The online version of this article (10.1186/s40798-018-0125-4) contains supplementary material, which is available to authorized users.

Development, Implementation, and Evaluation of an Interdisciplinary Theory- and Evidence-Based Intervention to Prevent Childhood Obesity: Theoretical and Methodological Lessons Learned

Overweight and obesity in children and adolescents is seen as a global health challenge and a priority for prevention (1). To solve such a health issue, we need full understanding of the related health behaviors (and underlying beliefs), and understanding of the biological mechanisms that cause or can prevent the issue. However, for overweight and obesity, drawing a full picture of the exact problem (and the subsequent solution) is difficult. In this paper, we describe how we used Intervention Mapping to develop a theory and evidence-based prevention program targeting overweight and obesity and how we investigated the 1-year efficacy of this program on body composition and physical activity of adolescents. A helpful tool, theoretical, and methodological lessons learned are given from our attempt to contribute to solving the obesity problem.

Local professionals' perceptions of health assets in a low-SES Dutch neighbourhood: a qualitative study

Background

Asset-based approaches have become popular in public health. As yet it is not known to what extent health and welfare professionals are able to identify and mobilise individual and community health assets. Therefore, the aim of this study was to understand professional’s perceptions of health and health assets.

Methods

In a low-SES neighbourhood, 21 health and welfare professionals were interviewed about their definition of health and their perceptions of the residents’ health status, assets available in the neighbourhood’s environment, and the way residents use these assets. A Nominal Group Technique (NGT) session was conducted for member check. Verbatim transcripts of the semi-structured interviews were coded and analysed using Atlas.ti.

Results

The professionals used a broad health concept, emphasizing the social dimension of health as most important. They discussed the poor health of residents, mentioning multiple health problems and unmet health needs. They provided many examples of behaviour that they considered unhealthy, in particular unhealthy diet and lack of exercise. Professionals considered the green physical environment, as well as health and social services, including their own services, as important health enhancing factors, whereas social and economic factors were considered as major barriers for good health. Poor housing and litter in public space were considered as barriers as well. According to the professionals, residents underutilized neighbourhood health assets. They emphasised the impact of poverty on the residents and their health. Moreover, they felt that residents were lacking individual capabilities to lead a healthy life. Although committed to the wellbeing of the residents, some professionals seemed almost discouraged by the (perceived) situation. They looked for practical solutions by developing group-based approaches and supporting residents’ self-organisation.

Conclusions

Our study shows, firstly, that professionals in the priority district Slotermeer rated the health of the residents as poor and their health behaviour as inadequate. They considered poverty and lack of education as important causes of this situation. Secondly, the professionals tended to talk about barriers in the neighbourhood rather than about neighbourhood health assets. As such, it seems challenging to implement asset-based approaches. However, the professionals, based on their own experiences, did perceive the development of collective approaches as a promising direction for future community health development.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4555-6) contains supplementary material, which is available to authorized users.

Effect of Community-Based Social Skills Training and Tai-Chi Exercise on Outcomes in Patients with Chronic Schizophrenia: A Randomized, One-Year Study

BACKGROUND

Antipsychotic drugs are limited in their ability to improve negative symptoms, quality of life, and medication adherence in patients with schizophrenia. The addition of nonpharmacological interventions like social skills training has a positive effect on medication adherence and decreases rehospitalization rates but is limited in improving patients' symptoms, aggressive behaviors, and quality of life. Aerobic exercise, especially Tai-chi, can potentially reduce psychopathological and negative symptoms, decrease aggressive behaviors, and improve quality of life. It is an ideal rehabilitation intervention for patients with schizophrenia. However, no study has investigated the effects of social skills training plus Tai-chi on outcomes among outpatients with schizophrenia. This study analyzes the effect of antipsychotics combined with community-based integrated interventions on outcomes of schizophrenia.

METHODS

In this study, a 24-session social skills training plus Tai-chi was used in community settings among patients with schizophrenia. A total of 244 patients were randomly assigned to medication treatment alone (MTA group) or community-based integrated intervention (CBII group), which accepted social skills training plus Tai-chi in addition to medication treatment. Generalized linear mixed models were used to evaluate the intervention effect (group effect), intervention effect over time (time effect), and interaction effect (group × time effect). t tests were used to evaluate between-group differences on clinical variables. Multiple linear regression analysis was used to analyze the differences between the intervention at 12 months and baseline for the Positive and Negative Syndrome Scale (PANSS) negative symptoms and quality of life-social domain.

RESULTS

Compared with the MTA group, the CBII group had lower scores on PANSS (F = 17.312, p < 0.001) and negative symptoms (F = 44.909, p < 0.001), a lower risk for aggressive behavior (F = 12.382, p < 0.001), and a greater improvement in adherence to medication (F = 12.391, p < 0.001) after 1 year of intervention. The changes in PANSS total scores, negative scores, and social domain of the World Health Organization Quality of Life Scale-Brief version (WHOQOL-BREF) from baseline to 12 months were significant between the two groups (PANSS total score: t = 4.839, p < 0.001; negative symptoms: t = 8.250, p < 0.001, and quality of life-social domain: t = -2.171, p = 0.031). Multiple linear regression analysis also showed that the intervention was significantly effective for changes from baseline to 12 months on PANSS total score (B = 0.804, p < 0.001), negative score (B = 0.709, p < 0.001), and social domain of quality of life (B = -0.673, p = 0.044).

CONCLUSIONS

This study suggested that the community-based integrated intervention such as social skills training plus Tai-chi should be part of a rehabilitation effort for patients with schizophrenia in order to improve clinical symptoms, quality of life, and medication adherence.