[Employment prospects of persons with severe mental illness after an integrated mental and psychomotor training in a vocational rehabilitation programme]. / Resultaten van integratie van mentale en psychomotorische training bij arbeidsrehabilitatie voor mensen met psychische aandoeningen.

BACKGROUND: There is a lower employment rate among persons with severe mental illness.
AIM: In order to increase the employment rate among mentally ill patients, azertie, a centre for vocational rehabilitation, has integrated a combination of psychomotor and mental training (the I Care concept) into its vocational rehabilitation programme. We investigated the results of the azertie system via a pilot study
METHOD: Over a period of 10 week period of guided training for work, persons with severe mental illness receive three sessions per week of mental training and psychomotor training.
RESULTS: 149 clients participated in the study. Of these, 70 clients (47%) found employment within the year. 50 participants were still receiving training; of these, 10 (6.7%) were likely to find employment. At a follow-up after at least one year of employment 90% of the clients was still at work.
CONCLUSION: The results of this pilot study should be interpreted with some caution because we did not use a control group. Nevertheless, when we compare the total employment rate (53.7%) with the employment rate in the period before the start-up of the I Care programme (10%) we can conclude that our programme led to a five-fold increase in the percentage of persons in this vulnerable group.

Yoga in schizophrenia: a systematic review of randomised controlled trials.

OBJECTIVE: The objective of this systematic review was to assess the effectiveness of yoga as a complementary treatment on general psychopathology, positive and negative symptoms and health-related quality of life (HRQL) for people with schizophrenia. METHOD: Randomised controlled trials (RCTs) were considered whether they investigated a yoga intervention in patients with schizophrenia. The selection of studies, data extraction and quality assessment were performed independently by two reviewers. RESULTS: Only three RCTs met the inclusion criteria. Lower Positive and Negative Syndrome Scale (PANSS) total scores and subscale scores for positive and negative symptoms were obtained after yoga compared with exercise or waiting list control conditions. In the same way, the physical, psychological, social and environmental HRQL as measured with the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) increased more significantly after yoga than after exercise or waiting list control conditions. None of the RCTS encountered adverse events. Dose-response relationships could, however, not be determined. CONCLUSION: Although the number of RCTs included in this review was limited, results indicated that yoga therapy can be an useful add-on treatment to reduce general psychopathology and positive and negative symptoms. In the same way, HRQL improved in those antipsychotic-stabilised patients with schizophrenia following yoga.

The functional exercise capacity is correlated with global functioning in patients with schizophrenia.

OBJECTIVE: The 6-minute walk test (6MWT) is commonly used to measure the functional exercise capacity in chronic patients with cardiovascular diseases. The purpose of this study was to determine whether the 6MWT is associated with the global assessment of functioning (GAF) score in patients with schizophrenia. METHODS: A total of 68 male and 25 female in-patients with schizophrenia (34.6 ± 9.7 years; body mass index = 24.9 ± 4.4) performed a 6MWT and were assessed with the GAF scale and the Psychosis Evaluation tool for Common use by Caregivers (PECC). RESULTS: The mean distance walked on the 6MWT was 587.3 ± 98.4 m, while the mean GAF score was 52.0 ± 10.4. The Pearson's correlation coefficient between the 6MWT and the GAF score was 0.59 (P < 0.001), indicating a moderate association between both measures. The 6MWT was also significantly related to negative (r = -0.45, P < 0.001), depressive (r = -0.48, P < 0.001) and cognitive (r=, P) symptoms and with body mass index (r = -0.31, P < 0.005), smoking behaviour (r = -0.36, P < 0.001)) and dose of antipsychotic medication (r = -0.38, P < 0.001). CONCLUSION: Next to the GAF scale, clinicians in in-patient settings should consider incorporating the 6MWT into their test battery to measure the functional consequences of schizophrenia and its treatment.

A systematic review of correlates of physical activity in patients with schizophrenia.

OBJECTIVE: The present review evaluates systematically the published quantitative studies of correlates of PA in patients with schizophrenia. METHOD: EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL and PEDro were searched from their inception to 1 July 2011 combining the medical subject heading 'schizophrenia' with 'physical activity' or 'physical inactivity' or 'exercise' or 'health education' or 'health behaviour' or 'health promotion'. RESULTS: Out of 68 potentially eligible studies, 25 papers (n = 25,013) evaluating 36 correlates were included. Correlates consistently associated with lower PA participation are the presence of negative symptoms and cardio-metabolic comorbidity. Also, side-effects of antipsychotic medication, lack of knowledge on cardiovascular disease risk factors, no belief in the health benefits, a lower self-efficacy, other unhealthy lifestyle habits and social isolation correlated with lower PA participation. The quality of the PA measurement was not related to the proportion of significant associations (χ(2) = 3.8, P = 0.07). Current gaps in literature that need to be examined more in detail are the role of environmental and policy-level factors on PA participation in patients with schizophrenia. CONCLUSION: All correlates should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.

Eurofit test battery in patients with schizophrenia or schizoaffective disorder: reliability and clinical correlates.

OBJECTIVE: To investigate the reproducibility of the Eurofit physical fitness test battery in patients with schizophrenia or schizoaffective disorder. Secondary aims were to assess clinical and demographic characteristics that correlate with the performance on the Eurofit and evaluation of the feasibility of the test. METHODS: Fifty patients with schizophrenia or schizoaffective disorder (mean age of 32.9±9.5 years) with a mean body mass index (BMI) of 26.1±6.0 kg/m(2) performed two Eurofit tests administered within 3 days. RESULTS: All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.72 for flamingo balance to 0.98 for standing broad jump test. All participants could perform five of the seven test items without problems. The whole body balance and abdominal muscle endurance test could be executed by 74 and 90%, respectively. Significant correlations were found with age, BMI, waist circumference, dose of antipsychotic medication and extrapyramidal, negative and cognitive symptoms. CONCLUSIONS: The Eurofit test showed good reproducibility and can be recommended for evaluating physical fitness parameters in patients with schizophrenia or schizoaffective disorder. Physical fitness measures were related to both physical and mental health parameters.

[Body-directed techniques on psychomotor therapy for people with schizophrenia: a review of the literature]. / Lichaamsgerichte werkvormen binnen de psychomotorische therapie voor mensen met schizofrenie: een literatuuronderzoek.

BACKGROUND: Patients with schizophrenia frequently undergo a disturbance of body experience. This can occur during an acute psychotic phase or during a period of remission. AIM: To investigate the scientific evidence of the effects of introducing body-directed techniques into psychomotor therapy for patients with schizophrenia. METHOD: PubMed, PEDro, CINAHL, psycINFO and SPORTDiscus were searched form 1 January, 2000, tot 1 January 2011, for reports of randomised controlled trials, controlled clinical trials and for studies wit a different design. The Tijdschrift voor Psychiatrie (the Dutch Journal of Psychiatry), the Tijdschrift voor Vaktherapie (The Journal for Special therapies) and Actuele Themata (Actual Themes) in psychomotor therapy were also screened. The quality of the methodology was assessed with the help of a checklist. Evidence for the efficacy of the interventions was summarised on the basis of a best-evidence synthesis. RESULT: Eleven studies satisfied our inclusion and exclusion criteria. There was a strong evidence for the reduction of psychiatric symptoms after yoga and reduced feelings of anxiety and stress after progressive muscle relaxation. There is limited evidence for yoga in reducing feelings of anxiety and stress and for body-directed group techniques in reducing negative symptoms. Qualitative research reported that mindfulness ­ and massage-techniques were able to considerably reduce feelings of stress. There is no evidence for the beneficial effects of dancing techniques. CONCLUSION: A body-directed approach can be effective an deserves to be included in the multidisciplinary treatment of schizophrenia.

Association of the metabolic syndrome with physical activity performance in patients with schizophrenia.

AIM: The primary aim of this study was to determine whether the presence of the metabolic syndrome (MetS) limits physical activity (PA) in patients with schizophrenia. A secondary aim was to investigate cross-sectional associations of leisure-time PA, sports participation and PA performance with MetS parameters. METHODS: Patients with schizophrenia who had MetS (n=37) were compared with those without MetS (n=69). Patients were assessed for PA performance using a 6-minute walk test (6MWT) and PA participation using the Baecke PA questionnaire, as well as for antipsychotic medication dose (expressed in chlorpromazine equivalents), negative symptoms and smoking behaviour. RESULTS: The two patient groups were similar in age, gender, mean antipsychotic medication dose, negative symptomatology and smoking behaviour. Distance achieved on the 6MWT was 13.7% shorter (P<0.001) in patients with versus patients without MetS (527.6±108.9 m vs 610.0±93.7 m, respectively). Patients with MetS were also significantly less involved in sports activities (P=0.001) and less physically active during leisure time (P=0.002). Also, the distance of the 6MWT was moderately correlated with body mass index (r=-0.44, P<0.001), waist circumference (r=-0.43, P<0.001), sports participation (r=0.60, P<0.001) and leisure-time PA (r=0.42, P<0.001). CONCLUSION: MetS is associated with poorer PA performance in patients with schizophrenia. The additional burden of MetS places patients with schizophrenia at even greater risk for physical and functional limitations in daily life.

Relationships between obesity, functional exercise capacity, physical activity participation and physical self-perception in people with schizophrenia.

OBJECTIVE: This study compared differences in functional exercise capacity between patients with schizophrenia and healthy controls. Physical self-perception and physical activity variables contributing to the variability in the distance achieved during a walk test were identified. METHOD: A total of 25 normal weight, 25 overweight and 10 obese patients and 40 healthy volunteers were included. Functional exercise capacity was explored with a 6-minute walk test. Level of physical activity was assessed using the Baecke questionnaire and physical self-perception using the physical self-perception profile. RESULTS: Obese patients walked a significantly shorter distance than overweight and normal weight patients (450.6 ± 97.7, 580.2 ± 116.0 and 615.8 ± 92.4 m resp., P < 0.001). All patients walked a shorter distance than healthy controls (710.6 ± 108.4 m, P < 0.001). Dyspnoea was only prevalent in schizophrenia (28.3%, P < 0.001) and especially in obese patients (90% vs. 40% in overweight and 27.3% in normal weight patients, P < 0.001). In multiple regression analysis, 59% of the variance in walking distance was explained by body mass index, perceived sports competence and condition, physical self-worth, level of sports participation and smoking behaviour. CONCLUSION: Functional exercise capacity in patients with schizophrenia is reduced not only by obesity, perceived discomfort and pain but also by a sedentary, unhealthy life style and a reduced physical self-perception.

[The therapeutic value of physical exercise for people with schizophrenia]. / De therapeutische waarde van bewegen voor mensen met schizofrenie.

BACKGROUND: Only about 25% of people with schizophrenia follow the public health recommendations for a minimum of 150 minutes per week of moderate physical exercise. In their leisure time people diagnosed with schizophrenia take considerably less exercise than their healthy counterparts. AIM: To collect scientific evidence of movement-related interventions in patients with schizophrenia. METHOD: PubMed, PEDro, CINAHL, PsychINFO and Sport Discus were searched for the period from 2003 up to April 2009 for reports of randomised controlled trials (RCTs) on the basis of the search terms 'schizophrenia', 'exercise' and 'physical activity'. Relevant literature was also traced by means of the reference lists for selected articles. RESULTS: Eight RCTs were selected. Physical exercise was reported to bring about significant improvements in cardiovascular and metabolic parameters and in psychiatric symptomatology. A physical exercise also has social advantages; it helps patients to cope with stress and improves their quality of life. CONCLUSION: Physical exercise as part of psychomotor therapy should play an important role within the multidisciplinary treatment of schizophrenia. More research is needed into the effect of physical activity on cognitive functioning.

State anxiety and subjective well-being responses to acute bouts of aerobic exercise in patients with depressive and anxiety disorders.

OBJECTIVE: Acute aerobic exercise is associated with a reduction in state anxiety and an improvement in subjective well-being. The objective of the present study was to contrast the effects of aerobic exercise at self-selected intensity versus prescribed intensity on state anxiety and subjective well-being (negative affect, positive well-being and fatigue) in patients with depressive and/or anxiety disorders. In addition, the potential impact of heart rate feedback was assessed. METHODS: Nineteen men and 29 women performed three test conditions on a bicycle ergometer during 20 minutes: two tests at self-selected intensity; one with and another without heart rate feedback, and a third test at the prescribed intensity of 50% of the maximal heart rate reserve according to Karvonen. Tests were executed in random order. State anxiety and subjective well-being were evaluated using the state anxiety inventory and the subjective exercise experiences scale. RESULTS: After 20 minutes cycling, patients showed significantly decreased state anxiety and negative affect in the three conditions. The magnitude of the reduction did not differ significantly between the three conditions. Only cycling at self-selected intensity enhanced positive well-being. Cycling at 50% of the maximal heart rate reserve decreased fatigue, whereas cycling at self-selected intensity increased fatigue. CONCLUSIONS: The response in state anxiety and negative affect was unaffected by the type of aerobic exercise. Self-selected intensity influenced exercise-induced changes in positive well-being and fatigue in a positive and negative way, respectively.

Assessing the additional impact of fitness training in depressed psychiatric patients receiving multifaceted treatment: a replicated single-subject design.

PURPOSE: Exercise has been put forward as a therapeutic means for the treatment of clinical depression. METHODS: In this study, 29 patients, all with diagnosed with mood disorder, completed daily measurements of depression and physical well-being during periods ranging from 77 to 436 days (M = 146.5). Fitness training was added to the treatment after a period and changes before (A-phase) and after (B-phase) the implementation of this training were the subject of investigation. Data were analysed by means of randomization tests with an AB-design and time-series analysis. Replication of the findings was investigated using Fisher's multiplicative method. RESULTS: Adding fitness training to the treatment of clinical depression does not systematically lead to changes in self-reported feelings of depression on top of benefits that may be due to other treatments. CONCLUSIONS: Since the present findings are not in agreement with previous studies, the absence of statistically significant changes in self-reported feelings of depression is discussed within the complexity of the 'exercise - depression' relationship in inpatient populations. These included the severity of their depression, the potential ceiling effect of a multifaceted treatment programme and the initial increase in depression due to the confrontational nature of the intervention.

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability.

PURPOSE: The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion. METHOD: Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week. RESULTS: The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82). CONCLUSIONS: The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial.

OBJECTIVE: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept. DESIGN: Randomized controlled parallel-group trial with repeated measures. SETTING: Three treatment units of a university psychiatric hospital in Belgium. SUBJECTS: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders. INTERVENTIONS: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks. OUTCOME MEASURES: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile. RESULTS: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness. CONCLUSIONS: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Changes in psychological well-being in female patients with clinically diagnosed depression: an exploratory approach in a therapeutic setting.

The objective of this exploratory one-group pretest-posttest study was to evaluate the nature of psychological change in inward depressed psychiatric patients attending multi-disciplinary treatment, including physical activity, designed to improve mental well-being. Female depressed psychiatric patients (n = 51) were examined before and after this programme over a period of 3 months. The following psychological parameters were assessed: depression, anxiety, global self-esteem, and physical self-perceptions. Depressed patients demonstrated statistically significant improvements in depression, anxiety, global self-esteem and physical self-worth (t(50) ranging from -3.76 to 4.65, all p < 0.007; ES ranging from 0.53 to -0.65). Changes in depression and anxiety displayed a strong negative correlation with changes in global self-esteem, and those changes are independent of the initial severity of the depressive symptoms ( F(2,48) ranging from 0.03 to 0.70, n.s.). Patients with greater improvement in physical self-perceptions reported greater improvement anxious symptoms then patients who did not improve. Consequently, within the limitations of the research design it can be concluded that the programme appeared successful in improving psychological well-being in female depressed patients. Results also provide preliminary insight into the potential role of the physical self in recovery.

Improvements in physical fitness of non-psychotic psychiatric patients following psychomotor therapy programs.

AIM: To investigate the changes in physical fitness after participation in 1 of 2 psychomotor therapy programs in a sample group of non-psychotic psychiatric patients. EXPERIMENTAL DESIGN: randomized controlled parallel group trial with follow-up measures after 8 weeks and after 16 weeks. SETTING: 3 treatment units of a university psychiatric hospital in Belgium. PATIENTS: 141 (51 males, 90 females) patients with severe depressive and/or anxious symptoms, and/or personality disorders. INTERVENTIONS: patients followed a personalized psychomotor fitness program (PF), consisting of aerobic and resistance training, or a general program of psychomotor therapy (GPMT), consisting of different forms of physical exercises and relaxation training. MEASURES: the maximum dynamic strength, the strength endurance and physical work capacity at 60% and 80% of the estimated maximal heart rate reserve. RESULTS: After 8 weeks it was observed that the PF group enhanced in all parameters of cardio-respiratory as well as muscular fitness; the GPMT group had improved in 7 out of the 9 muscular fitness measurements. At the end of the 16 weeks, both groups had shown an improvement in all of the muscular fitness parameters, but only the PF group had increased in cardio-respiratory fitness. CONCLUSION: In order to improve both muscular and cardio-respiratory fitness in these patients, a balanced personalized training program, which includes aerobic and resistance training, is necessary during a period of at least 8 weeks. The less specific GPMT, when followed for a period of 16 weeks, is sufficient for improving muscular fitness and for maintaining cardio-respiratory fitness.

[Treatment of chronic psychoses with oral clopimozide].

A longterm investigation containing three distinct studies has been carried out in order to clarify efficacy and inocuity of clopimozide in the maintenance treatment of chronic psychotics. Twelve patients took part in the pilot study (Study I) during which the optimal weekly dose was established to be 24 mg. These patients were then subdivided into two groups for a controlled study with placebo (Study II). This double-blind evaluation has clearly established the superiority of cloprimozide over placebo. Patients were evaluated at the start and completion of the study with three scales. During the surveillance period (Study III), clopimozide was administered daily with a mean dose of 2.5 mg. Results were equally satisfying as those obtained during weekly treatment. The appearance of side-effects, mostly akatsia and dyskinesia, was only noted during the weekly administration. They could be efficiently controlled with dexetimide.