Reliability and clinical correlates of the Astrand-Rhyming sub-maximal exercise test in patients with schizophrenia or schizoaffective disorder

Cardiovascular fitness is reduced in people with schizophrenia and is related to an increased morbidity and mortality. There is mounting interest in the accurate measurement of cardiovascular fitness in schizophrenia, yet existing measures used in the general population have not been tested on validity and reliability in this high-risk group. Therefore, we examined the reproducibility and feasibility of the Astrand-Rhyming sub-maximal exercise test in patients with schizophrenia or schizoaffective disorder. Secondary aims were to assess minimal detectable changes, practice effects and the presence of clinical symptoms that are associated with cardio-respiratory fitness (expressed as estimated oxygen uptake). From 47 patients with schizophrenia or schizoaffective disorder two trials of the Astrand-Rhyming test, administered within three days, were analysed. The intraclass correlation coefficient for the estimated oxygen uptake between the two tests was 0.92 (95% confidence interval: 0.85 to 0.95). The minimal detectable change was 6.5 mlO2/min/kg. No practice effect could be detected. A backward regression analysis demonstrated that illness duration, negative symptoms and level of physical activity explained 63.0% of the variance in estimated oxygen uptake. The current study demonstrates that the Astrand-Rhyming test can be recommended for evaluating the aerobic fitness in patients with schizophrenia or schizoaffective disorder

What are the top 10 physical activity research questions in schizophrenia?

Purpose: Research has only recently started to consider the applicability of physical activity (PA) for people with schizophrenia. Although there is increasing evidence for the benefits of physical activity, this population remains generally physically inactive and sedentary. The aim of the current study is to highlight 10 pertinent physical activity research questions in people with schizophrenia. Method: The International Organisation of Physical Therapy in Mental Health (IOPTMH) executed a consultation of its National Organisations (n=13) to identify the most salient questions relevant to guide clinical practice on physical activity in people with schizophrenia. Results: We identified the following 10 questions: (1) What are the benefits of physical activity for people with schizophrenia? (2) What are the mechanisms of the physical activity effects in people with schizophrenia? (3) What are the most prominent safety issues for physical activity prescription in people with schizophrenia? (4) What is the most optimal physical activity prescription for people with schizophrenia? (5) What are the key barriers for engaging people with schizophrenia in physical activity? (6) What are the most effective motivational interventions for physical activity adoption and maintenance in people with schizophrenia? (7) How do we translate physical activity research into clinical and community practice? (8) How can we ensure integration of physical therapists within the multidisciplinary mental health treatment team? (9) How can we prevent sedentary behaviour in people with schizophrenia? (10) What is the most appropriate physical activity assessment method in clinical practice? Conclusions: Addressing these questions is critical for developing evidence-based approaches for promoting and sustaining an active lifestyle in people with schizophrenia. Ultimately, achieving this will improve the quality of life of this population. Implications for Rehabilitation: · Investigation of behaviour change interventions for people with schizophrenia is critical · A low cost, easy to use, clinical, valid physical activity questionnaire is urgently needed

Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels

Background: Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions.Objective: The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa.Methods: Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’.Results: Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5-40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/μl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher’s exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03).Conclusion: The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.Keywords: Physical activity, exercise, physiotherapy, AIDS, HIV

Metabolic syndrome and lung function in schizophrenia: a pilot study

This pilot study aimed to explore relationships between metabolic and lung functions in patients with schizophrenia. Eighty patients with schizophrenia (55♂; 36.8±10.0 years) underwent a spirometry, were screened for metabolic syndrome (MetS), performed a 6-minute walk test (6MWT), and completed the International Physical Activity Questionnaire and the Psychosis evaluation tool for common use by caregivers. Patients with MetS (according to the International Diabetes Federation criteria) (n=28; 35%) had a reduced predicted forced expiratory volume for 1 second (77.4±13.2 versus 87.3±12.1%) and predicted forced vital capacity (75.3±11.1 versus 85.4±11.4%). Significantly more patients with MetS were diagnosed with restrictive lung dysfunction (RLD) (according to the Global Initiative for Chronic Obstructive Lung Disease criteria) (13 versus 8). Schizophrenia patients with RLD (n=21; 26.2%) had a significantly larger waist circumference (90.7±12.5 versus, 105.6±14.7 cm), were less physically active (653.6±777.9 versus 1517.9±1248.7 metabolic equivalent-min/week) and walked less on the 6MWT (502.6±92.3 versus 612.4±101.2 m) than patients without RLD. The present data suggest that in patients with schizophrenia RLD might be associated with metabolic dysfunctions. Further prospective analyses are required to elucidate the complex interrelationships between lung and metabolic functions in patients with schizophrenia

Is pain perception altered in people with depression? A systematic review and meta-analysis of experimental pain research

While clinical studies suggest depressed patients may be more vulnerable to pain, experimental research is equivocal. This meta-analysis aimed to clarify whether depression is associated with altered pain perception in response to noxious stimulation and to identify factors that might influence this association. A search of major electronic databases was conducted to identify experimental studies investigating pain response in depressed participants vs. healthy controls using established pain outcome measures. Random effects meta-analysis of standardized mean differences was conducted on data from 32 studies (N=1,317). For high-intensity noxious stimulation, overall pain tolerance was similar across depressed and control groups (Hedge's g=0.09, p=0.71, studies=10). For low-intensity stimulation, a small, but statistically significant higher mean sensory threshold (g=0.35, p=0.01, studies=9) and pain threshold (g=0.32, p=0.02, studies=25) was observed in depressed participants, suggesting diminished pain. However, considerable heterogeneity in the direction and magnitude of effects was observed, indicating a likely condition-specific impact of depression on pain. Subgroup analysis found that pain threshold/tolerance was increased in depression for exteroceptive (cutaneous) stimulation but decreased for interoceptive (ischemic) stimulation, but that substantial heterogeneity remained. Overall, results provide some support for altered pain processing in depression, but suggest this link is dependent upon modality and additional, unidentified factors

A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia

<p><i>Purpose</i>: To review and synthesise the literature detailing the use of social support to facilitate physical activity participation in individuals with schizophrenia. <i>Method</i>: A systematic review of major electronic databases was conducted to identify literature regarding the use of social support to promote physical activity among people with schizophrenia. A narrative synthesis was undertaken in four stages, including development of a theory, developing a preliminary synthesis, exploring relationships and assessing the robustness of the synthesis. <i>Results</i>: From a total of 110 studies, 23 met the inclusion criteria including 883 individuals with schizophrenia. Informational support was the most documented form of social support, followed by emotional, esteem and tangible. Providers included research personnel, healthcare professionals, family members and peers. Details of the content of the different dimensions of functional support are given. Social support appears to have an important role to help individuals with schizophrenia initiate, comply and adhere with exercise interventions. Social support may have an indirect benefit on weight maintenance. However, due to the limitations of the selected literature, it was difficult ascertain what the (in)direct benefit of social support are on health outcomes. <i>Conclusions</i>: Social support appears to play a pivotal role in initiating physical activity as well as ensuring compliance and adherence to physical activity. Future research is required to investigate the optimal type and mode of delivery of social support on health outcomes.Implications for Rehabilitation</p><p>Limited evidence is available that considers the role, value and use of social support within physical activity interventions for individuals with schizophrenia.</p><p>Social support appears most likely to aid an individual’s initiation, adherence and compliance to physical activity interventions.</p><p>There may be an indirect benefit of social support on maintaining or enhancing health outcomes.</p><p></p> <p>Limited evidence is available that considers the role, value and use of social support within physical activity interventions for individuals with schizophrenia.</p> <p>Social support appears most likely to aid an individual’s initiation, adherence and compliance to physical activity interventions.</p> <p>There may be an indirect benefit of social support on maintaining or enhancing health outcomes.</p

A Cognitive-Behavioural Program (One Day a Week) for Patients With Obesity and Binge Eating Disorder: Short-Term Follow-up Data

This paper describes an innovative cognitive behavioural program for the treatment of patients with binge eating disorder in the University Psychiatric Center K.U. Leuven Campus Kortenberg in Belgium. The program runs one day a week during 6 months and consists of 24 sessions. The most important therapeutic goals are: (1) normalization of eating habits and stopping the binge eating episodes; (2) promoting physical activity and a positive body experience; (3) learning specific skills such as assertivity, installing a functional self-evaluation system; learning to identify, tolerate and express negative emotions, promoting self-esteem and prevention of relapse. Overall, the goal is to promote both physical and psychological well-being and quality of life. Some preliminary research data on the effectiveness of this program are described. Despite a rather limited weight loss, the number of binges per week decreased significantly, which was the main therapeutic goal of the treatment. Furthermore, the results show some promising improvements on different psychological parameters in BED patients

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Individuals living with schizophrenia are 2–3 times more likely to experience type 2 diabetes mellitus. Diabetes medication adherence is essential to reduce morbidity and mortality in this population. We conducted a meta-analysis of diabetes medication adherence among people with schizophrenia, and compared this to those without schizophrenia. A systematic search strategy was used to identify all articles reporting adherence to diabetes medications among patients with schizophrenia. In total, 10 unique studies reporting data from 33,910 people with schizophrenia were included. Random effects meta-analysis showed people with schizophrenia adhered to medication on 77.3% of days prescribed (n=32080, 95%CI=73.6–81%, I2=99.2%,), and adhered on 4.6% more days per year than those without schizophrenia (p&lt;0.01, 95%CI=2.4–6.7%, I2=92.5%, schizophrenia n=19367, controls=170,853). Furthermore, 56% of individuals with schizophrenia (n=33680) were considered “adherent” (i.e. &gt;80% adherence over 12–24 month) to diabetes medication, which was significantly more than those without schizophrenia (OR=1.34, 95%CI: 1.18–1.52, p&lt;0.01). Factors which were positively associated with diabetes medication adherence were age, number of outpatient visits, along with multiple medication administration variables. Future prospective research should examine diabetes monitoring, medication prescription, and subsequent adherence in fully representative samples. Novel interventions for maximizing compliance to diabetes medication in this vulnerable population should also be explored

A systematic review of physical activity correlates in alcohol use disorders

Background: Physical activity might promote mental and physical health in persons with alcohol use disorder. Understanding the barriers and facilitators of participation in physical activity in persons with alcohol use disorder is an essential first step in order to devise effective physical activity interventions. Objective: The present review provides a systematic quantitative review of the correlates of physical activity in people with alcohol use disorder. Methods: Major electronic databases were searched by two independent authors from inception till June 2014. Keywords included ‘physical activity’ or ‘exercise’ and ‘alcohol dependence’ or ‘alcohol abuse’ or ‘alcohol use disorders’ or ‘alcoholism’. Results: Five papers evaluating 14 correlates were included. Three studies reported that alcohol dependence was unrelated to physical activity behavior, while alcohol abuse showed positive associations in 2 studies. No demographic variable was related with physical activity participation. Functional impairments and distress associated with alcohol use disorders including increased smoking rates, obesity, anxiety, depression and a lower self-efficacy may limit one’s ability to be physically active. Data on social, environmental and policy related factors are currently lacking. No included study assessed physical activity levels utilizing objective measurements (e.g. pedometers, accelerometers). Conclusion: Although the literature on physical activity correlates in persons with alcohol use disorder still is equivocal, our varied findings support the hypothesis that the participation in physical activity by people with alcohol use disorder is determined by a range of complex factors