An impaired health related muscular fitness contributes to a reduced walking capacity in patients with schizophrenia: a cross-sectional study

BMC Psychiatry

Marc De Hert⁴  Dirk De Wachter⁴  Attilio Carraro²  Rui Manuel Nunes Corredeira³  Amber De Herdt¹  Michel Probst¹  Davy Vancampfort⁴ 

[1] Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium;Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padua, Padova, Italy;CIAFEL - Centre for Research on Physical Activity, Health and Leisure, University of Porto, Porto, Portugal;University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium

关键词: Schizophrenia;    Walking;    Metabolic syndrome;    Physical activity;    Fitness;    Muscle weakness;   

Others  :  1124188
DOI  :  10.1186/1471-244X-13-5

 received in 2012-08-17, accepted in 2013-01-02,  发布年份 2013

【 摘 要 】

Background

Patients with schizophrenia report muscle weakness. The relation of this muscle weakness with performing daily life activities such as walking is however not yet studied. The aim of this study was to quantify walking capacity and health related muscular fitness in patients with schizophrenia compared with age-, gender and body mass index (BMI)-matched healthy controls. Secondly, we identified variables that could explain the variability in walking capacity and in health related muscular fitness in patients with schizophrenia.

Methods

A total of 100 patients with schizophrenia and 40 healthy volunteers were initially screened. Eighty patients with schizophrenia (36.8±10.0 years) and the 40 age-, gender- and body mass index (BMI)-matched healthy volunteers (37.1±10.3 years) were finally included. All participants performed a standing broad jump test (SBJ) and a six-minute walk test (6MWT) and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms.

Results

Patients with schizophrenia did have lower 6MWT (17.9%, p<0.001) [effect size (ES)=−1.01] and SBJ (14.1%, p<0.001) (ES=−0.57) scores. Patients were also less physically active (1291.0±1201.8 metabolic equivalent-minutes/week versus 2463.1±1365.3, p<0.001) (ES=−0.91) than controls. Schizophrenia patients with metabolic syndrome (MetS) (35%) had a 23.9% lower (p<0.001) SBJ-score and 22.4% (p<0.001) lower 6MWT-score than those without MetS. In multiple regression analysis, 71.8% of the variance in 6MWT was explained by muscular fitness, BMI, presence of MetS and physical activity participation, while 53.9% of the variance in SBJ-score was explained by age, illness duration, BMI and physical activity participation.

Conclusions

The walking capacity and health-related muscular fitness are impaired in patients with schizophrenia and both should be a major focus in daily clinical practice and future research.

【 授权许可】

   
2013 Vancampfort et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Strassnig M, Brar JS, Ganguli R: Low cardiorespiratory fitness and physical functional capacity in obese patients with schizophrenia. Schizophr Res 2011, 126:103-109.
• [2]Scheewe TW, Takken T, Kahn RS, Cahn W, Backx FJ: Effects of exercise therapy on cardiorespiratory fitness in schizophrenia patients. Med Sci Sports Exerc 2012, 44(10):1834-1842.
• [3]Galletly C: Subjective muscle weakness and hypotonia during clozapine treatment. Ann Ann Clin Psychiatr 1996, 8(4):189-192.
• [4]Vancampfort D, Probst M, Sweers K, Maurissen K, Knapen J, De Hert M: Relationships between obesity, functional exercise capacity, physical activity participation and physical self perception in people with schizophrenia. Acta Psychiatr Scand 2011, 123:423-430.
• [5]Vancampfort D, Sweers K, Probst M, Maurissen K, Knapen J, Minguet P, De Hert M: The association of metabolic syndrome with physical activity performance in patients with schizophrenia. Diabetes Metab 2011, 37:318-323.
• [6]Vancampfort D, Probst M, Scheewe T, Knapen J, De Herdt A, De Hert M: The functional exercise capacity is correlated with global functioning in patients with schizophrenia. Acta Psychiatr Scand 2012, 125(5):382-387.
• [7]Martín-Sierra A, Vancampfort D, Probst M, Bobes J, Maurissen K, Sweers K, De Schepper E, De Hert M: Walking capacity is associated with health related quality of life and physical activity level in patients with schizophrenia: a preliminary report. Actas Esp Psiquiatr 2011, 39(4):211-216.
• [8]De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S: Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatr 2011, 10:52-77.
• [9]De Hert M, Dekker JM, Wood D, Kahl KG, Holt RIG, Möller H-J: Cardiovascular disease and diabetes is people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatr 2009, 4:412-424.
• [10]Vancampfort D, Sweers K, Probst M, Mitchell A, Knapen J, Hert D: Quality assessment of physical activity within clinical practice guidelines for the prevention and treatment of cardio-metabolic risk factors in persons with schizophrenia. Community Ment Health J 2011, 47(6):703-710.
• [11]Vancampfort D, Knapen J, De Hert M, van Winkel R, Deckx S, Maurissen K, Peuskens J, Simons J, Probst M: Cardiometabolic effects of physical activity interventions for people with schizophrenia. Phys Ther Rev 2009, 14:388-398.
• [12]Faulkner G, Cohn T, Remington G: Validation of a physical activity assessment tool for individuals with schizophrenia. Schizophr Res 2006, 82:225-231.
• [13]Vancampfort D, Knapen J, Probst M, Scheewe T, Remans S, De Hert M: A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand 2012, 125(5):352-362.
• [14]Vancampfort D, Knapen J, van Probst M, Winkel R, Deckx S, Maurissen K, Peuskens J, De Hert M: Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia. Psychiatr Res 2010, 177:271-279.
• [15]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Association; 2000. text revision
• [16]American College of Sports Medicine: ACSM's guidelines for exercise testing and prescription. 8th edition. Baltimore: Lippincott Williams & Wilkins; 2009.
• [17]American Thoracic Society: ATS statement: guidelines for the six-minute walk test. Am J Resp Crit Care Med 2002, 166:111-117.
• [18]Vancampfort D, Probst M, Sweers K, Maurissen K, Knapen J, De Hert M: Reliability, minimal detectable changes, practice effects and correlates of the 6-min walk test in patients with schizophrenia. Psychiatr Res 2011, 187:62-67.
• [19]Oja P, Tuxworth B: Eurofit for adults. Strasbourg: Council of Europe-UKK Institute, Tampere; 1995. [Assessment of health-related fitness]
• [20]Vancampfort D, Probst M, Sweers K, Maurissen K, Knapen J, Willems JB, Heip T, De Hert M: Measuring physical fitness by means of the Eurofit test battery in patients with schizophrenia: reliability and correlates with patients' characteristics. Eur Psychiatr 2012, 27(6):416-421.
• [21]Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 35:1381-1395.
• [22]Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS: Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000, 32:498-504.
• [23]De Hert M, Van Eyck D, Hanssens L, Peuskens H, Thys E, Wampers M, Scheen A, Peuskens J: Oral glucose tolerance tests in treated patients with schizophrenia. Data to support an adaptation of the proposed guidelines for monitoring of patients on second generation antipsychotics. Eur Psychiatr 2006, 21(4):224-226.
• [24]van Winkel R, De Hert M, Van Eyck D, Hanssens L, Wampers M, Scheen A, Peuskens J: Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods. J Clin Psychiatr 2006, 67(10):1493-1500.
• [25]Alberti KG, Zimmet P, Shaw J: Metabolic syndrome – a new world-wide definition, a consensus statement from the International Diabetes Federation. Diabet Med 2006, 23:469-480.
• [26]Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity: Harmonizing the metabolic syndrome. A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120:1640-1645.
• [27]De Hert M, Bussel J, Lindström E, Abrahams F, Franens C, Peuskens J: PECC, Psychosis Evaluation tool for Common use by Caregivers. Antwerpen, Belgium: EPO; 1998.
• [28]De Hert M, Wampers M, Thys E, Wiselgen I, Lindström E, Peuskens J: Validation study of PECC (Psychosis Evaluation tool for Common use by Caregivers): interscale validity and inter-rater reliability. Int J Psychiatr Clin Pract 2002, 6:135-140.
• [29]Gardner DM, Murphy AL, O'Donnell H, Centorrino F, Baldesarini RJ: International consensus study of antipsychotic dosing. Am J Psychiatry 2010, 167(6):686-693.
• [30]Viertö S, Sainio P, Koskinen S, Perälä J, Saarni SI, Sihvonen M, Lönnqvist J, Suvisaari J: Mobility limitations in persons with psychotic disorder: findings from a population-based survey. Soc Psychiatr Psychiatr Epidemiol 2009, 44(4):325-332.
• [31]Kern PA, Ranganatan S, Li C, Wood L, Ranganatan G: Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab 2001, 280:E745-E751.
• [32]Borg J, Edström L, Bjerkenstedt L, Wiesel FA, Farde L, Hagenfeldt L: Muscle biopsy findings, conduction velocity and refractory period of single motor nerve fibers in schizophrenia. J Neurol Neurosurg Psychiatry 1987, 50:1655-1664.
• [33]Vancampfort D, De Hert M, Skjerven LH, Gyllensten AL, Parker A, Mulders N, Nyboe L, Spencer F, Probst M: International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia. Disabil Rehabil 2012, 34:1-12.
• [34]Vancampfort D, Probst M, Helvik Skjaerven L, Catalán-Matamoros D, Lundvik-Gyllensten A, Gómez-Conesa A, Ijntema R, De Hert M: Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Phys Ther 2012, 92(1):11-23.
• [35]Vanhees L, Lefevre J, Philippaerts R, Martens M, Huygens W, Troosters T, Beunen G: How to assess physical activity? How to assess physical fitness? Eur J Cardiovasc Prev Rehabil 2005, 12:102-114.
• [36]De Bourdeaudhuij I, Sallis JF, Saelens BE: Environmental correlates of physical Activity in a sample of Belgian adults. Am J Health Prom 2003, 18(1):83-92.
• [37]De Cocker KA, De Bourdeauduuij IM, Brown WJ, Cardon GM: The effect of a pedometer-based physical activity intervention on sitting time. Prev Med 2008, 47(2):179-181.
• [38]World Health Organisation: Highlights on health in Belgium. Office for Health Promotion. Copenhagen, Denmark: World Health Organisation Regional Office for Europe; 2004.
• [39]Flyckt L, Borg J, Borg K, Ansved T, Edman G, Bjerkenstedt L, Wiesel FA: Muscle biopsy, macro EMG, and clinical characteristics in patients with schizophrenia. Biol Psychiatry 2000, 47(11):991-999.
• [40]Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL: Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012, 11(6):521-534.