Schizophrenia And Exercise

Schizophrenia and Physical Activity; From Theory to Practice

Kathi Cameron, BKin. MA (candidate) School of Physical Education University of Victoria

Introduction •

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Physical inactivity may be related to an increased risk of heart disease and stroke, colon and breast cancer, obesity, type 2 diabetes, and mental stresses such as depression and anxiety (Colman & Walker, 2004). In addition, it has been suggested that exercise may reduce depression and anxiety, enhance cognitive functioning, social interest, energy, and self-esteem. People with schizophrenia are at greater risk for obesity that may be compounded by the side effects of antipsychotic drugs (Green, Patel, Goisman, Allison, Blackburn, 2000). It has been suggested that moderate exercise should be prescribed to combat excessive weight gain (Green, et al.,2000). There is limited research available that examines the impact of exercise on those individuals with mental illness (Fogarty & Happel, 2005).

What does the literature suggest? •

Research suggests that 40-80% of people with schizophrenia taking antipsychotic medication gain weight exceeding the ideal body weight by 20% or greater (Umbricht, Pollack & Kane, 1994; Masand, Blackburn, Ganguli, Goldman & Gorman, 1999).

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Faulkner and Biddle (1999) reviewed 11 studies focused on exercise as an adjunct treatment for schizophrenia and found that the existing research suggests exercise is useful for the reduction of some of the negative symptoms of schizophrenia, depression and anxiety.

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Exercise was shown to reduce auditory hallucinations and improve sleep patterns, self-esteem and general behavior in people living with schizophrenia (Faulkner & Sparks, 1999).

What has been done? •

Six residents in a Community Care Unit in Melbourne, Australia participated in a three month structured exercise program and reported positive benefits in physical, mental, and social health (Fogarty & Happell, 2005).

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One study reported a significant reduction in depression levels and an increase in aerobic fitness for five patients with long term diagnosis of schizophrenia through the participation in an exercise program (Pelham, Campagna, Ritvo, & Bernie, 1993).

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Belcher (1988) found a 92% reduction in the occurrence of hallucinations among people with schizophrenia who participated in regular exercise.

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Participation in an exercise program has also been linked to the increase in self-image, reduced anxiety levels and agression (Sheehan, 1991; Sule, 1987).

Theories to Consider •

Health Belief Model

(Hochbaum, Kegels & Rosenstock, 1951)

• Behavior will occur if the individual believes the health risks are real, that preventative measures will be effective, perceives the behavior as possible and does not see many barriers.

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Transtheoretical Model

(Prochaska & DiClemente, 1986)

• Defines five stages an individual may go through when adopting a new behavior

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Theory of Planned Behavior

(Ajzen, 1985)

• Suggest there are three variables that may lead to the intent and ultimately the behavior itself.

Related Research… •

Courneya, Plotnikoff, Hotz, & Birkett (2001) • Over 50 studies looking at SOC and exercise behavior • PBC predicted inactive to active stages • There has been no longitudinal studies

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Sheeran, Conner, & Norman (2001) • PBC and Intention highest predictor of behavior • Less experienced with behavior = less intention to perform

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Armitage, Sheeran, Conner, & Arden (2004) • TPB variables provide discrimination between stages (I.e. maintenance stage = positive attitude • Behavior Intention may predict preparation and maintenance stage • Enhancing PBC may assist the individual through the stages

Determinants of Physical Activity •

Individual, social, and environmental factors play a significant role in the decision to be physically active.

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Considerations such as socioeconomic status, education levels, communities, and discrimination factors may all have an influence on the overall health and activity level of the individual (McElroy, 2002).

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Frankish, Milligan, and Reid (1998) support this by stating the importance of acknowledging the individual’s physical activity history, education level, beliefs and attitudes, and the influence of social networks on the success of physical activity adherence.

Considerations for Exercise Adherence •

Research suggests this population is no different than that of others in the adherence rates of exercise (60% drop out before six months).

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Group activity is best for enhanced social cohesion and exercise enjoyment.

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Those that do not choose their activities may not reap the mental health benefits and may drop out sooner than those that enjoy the activity they are participating in.

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Physical activity vs. exercise/fitness (enjoyment vs. measurement and evaluation)

So what? •

When designing an exercise program for individuals living with schizophrenia consider the following barriers to participation: • Personal beliefs and attitudes regarding exercise • Influences of fitness culture • Group cohesion • Personal choice • Exercise enjoyment • Convenience • Leader’s beliefs and attitudes regarding exercise

From Theory to Practice •

Partnership: • EMP Psychiatric Day Hospital & University of Victoria

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Location: • University of Victoria Fitness/Weight Center

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Program Design: • 2 sessions / week; 1.5 hours / session

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Duration: • 8 weeks

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Participation:

Program Design •

Screening of referrals through PAR-Q

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Progressive resistance exercise over 8 weeks

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“Star System” and journaling employed

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Support: • • • •

Personal trainer and volunteer supervision Therapist support Transportation support User fee support

Follow Up •

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Maintenance program transferred to Oak Bay Municipal Recreation Center Supporting one personal trainer One session per week Therapist intervention twice per week: • Social structure support • Responsible for journals • Responsible for admission

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Referrals continue to join

What did the participants have to say? •

Background: 2nd ST Program • 3 men / 7 women between the ages of 21-55 • 80% retention

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Client Feedback • “I noticed my depression would lift and I could workout some of my frustration and anger. My medication has been reduced since I started exercising.” • “It got me back into doing things I used to do. My illness made me withdraw. This allowed me to get my confidence back. To use the abilities I had lost.” • “Even if I get a reprieve from my depression of 20 minutes after exercising, it’s worth it.” • “I was less obsessed with the side effects of my meds and my illness and focused my frustration on the weights.”

Considerations for Program Leaders… • • •

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Exercise environment Acknowledge individual differences Make a personal connection with each participant Inclusion and cohesion Avoid judgment Make the shift from physiology to psychology!

Thank you for your time and attention!

Kathi Cameron, 250.472.4038 [email protected]