High Intensity Interval Training in Patients With Psychosis

• 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.

Study Design
• 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
 

Study Methods
• 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)

Results
• 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

Results (cont’d)
• 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

Discussion
• 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