Physical activity should be considered an important part of the management of metabolic complications in patients with psychotic disorders.
Physical activity should be considered an important part of the management of metabolic complications in patients with psychotic disorders
• Patients with schizophrenia have an increased prevalence of the metabolic syndrome, a major risk factor for cardiovascular disease morbidity and mortality
• Low physical activity, which is common in schizophrenia, contributes to metabolic syndrome risk in these patients1
• There is meta-analytic evidence that exercise training in patients with schizophrenia is associated with improvements in metabolic profile several domains of functioning2
• High Intensity Interval Training (HIIT) is a type of exercise consisting of alternating periods (generally lasting between 10 seconds and 4 minutes each) of short, high intensity activity (eg, sprinting) with less activity/recovery (eg, walking)
• HIIT may be superior to other forms of exercise (eg, jogging at a regular pace) in improving cardiorespiratory fitness3
• Romain and colleagues4 performed a 6-month randomized controlled trial of HIIT in patients with psychotic disorders
• The study aim was to investigate the effects of this program on body composition (especially waist circumference), metabolic, psychiatric, and functional markers in overweight patients with psychosis.
• 66 clinically stable patients age 18 to 55 years with non-affective or affective psychotic disorders were recruited from clinics in Montreal, Canada
• Inclusion criteria were patients taking antipsychotic medication; overweight (BMI≥25); waist circumferences meeting criteria for the metabolic syndrome (≥94cm for men and ≥80 cm for women); and inactivity (<2 sessions of structured physical activity per week
• Exclusion criteria were medical contraindication to exercise; cardiovascular disease; diabetes; orthopedic limitations; >2 alcoholic drinks/day; and taking medication for medical comorbidity
• The intervention group received 6 months of HIIT (sprinting and walking) performed on a treadmill twice weekly on non-consecutive days, with individual supervision
• Controls were randomized to a wait-list group with continued psychiatric care
• Participants were instructed not to change other lifestyle habits (eg, nutrition)
• All participants were offered a 6-month free membership at the study site exercise facility
Study Methods (cont’d)
• Participants absent for 2 weeks (4 sessions) or explicitly expressed the desire to quit the exercise intervention were considered dropouts
• Data were collected at baseline and 6 months
• Outcomes included waist circumference, body composition, cardiorespiratory fitness, blood pressure, lipid profile, glucose and HbA1c, illness severity, functioning, quality of life, and self-esteem
• Data were analyzed on an intent to treat basis using repeated-measures mixed linear models
• A secondary analysis was performed in compliant participants (completed ≥64% of sessions)
Study Methods (cont’d)
• 38 participants were randomized to the intervention and 28 participants to the control group
• Mean age was 31, and mean BMI was 32. 61% of participants were male and 55% were smokers
• 19 subjects (50%) randomized to HIIT and 3 subjects (11%) in the control group dropped out
• Mean participation in the HIIT group was 64% of sessions (98% in subjects who did not drop out)
• At 6 months, there was a non-significant reduction in waist circumference in subjects in the HIIT versus control groups (-1.7 cm)
• The exercise intervention was associated with significant improvement in global function, social functioning, and negative symptoms
• 7 participants in the intervention group had adverse events, including back, knee, and muscle pain; cramps; and one ankle sprain
• Compliant participants (completed ≥64% of sessions) had significant reduction in waist circumference (-2.9 cm) compared to controls
• Compliant participants also had significant improvements in global functioning, social functioning, and negative symptoms
• Hallucinations, and disorganization, as well as more depression, anxiety, and fatigue, and lower health-related quality of life
• There was no difference in antipsychotic dose between subjects with and without insomnia
• The authors concluded that a supervised HIIT is safe and well-tolerated in overweight patients with psychotic disorders
• Subjects compliant with the exercise program had improvements in waist circumference, negative symptoms, and functioning; however, dropout rates were high (50%)
• Physical activity should be considered an important part of the management of metabolic complications in patients with psychotic disorders
1. Janney CA, Ganguli R, Tang G, et al. Physical activity and sedentary behavior measured objectively and subjectively in overweight and obese adults with schizophrenia or schizoaffective disorders. Clin Psychiatry. 2015;76:e1277–e1284.
2. Dauwan M, Begemann MJH, Heringa SM, et al. Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis. Schizophr. Bull. 2016;42:588–599.
3. Weston KS, WislÃ¸ff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and metaanalysis. Br J Sports Med. 2014;48:1227–1234.
4. Romain AJ, Fankam C, Karelis AD, et al. Effects of high intensity interval training among overweight individuals with psychotic disorders: A randomized controlled trial. Schizophr Res. 2018 [Epub ahead of print].