The effect of a physical activity program on chronic psychiatric patients' positive and negative symptoms and depression levels: A randomized controlled trial

Abstract

Physical activity is widely recognized as an important behavioral means of risk prevention and illness management, or alternatively, recovery and the realization of well-being. Mental health nurses have a holistic approach to the health care of those with mental illness and physical activity is an important component of holistic care. This research was undertaken in order to analyze the effect a physical activity program has on positive and negative symptoms of patients with schizophrenia and their depression levels. This is a randomly controlled experimental study designed with a pre-test and post-test. The Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Calgary Depression Scale for Schizophrenia were used in this research. The study was carried out with 60 patients, 30 in the experimental and 30 in the control group. The Mann-Whitney U and Wilcoxon tests were used, and the Cronbach's alpha coefficient was calculated. It was found that there was a significant difference between the mean scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (p<0.05.) According to this study's findings, the physical activity program for patients with schizophrenic had a statistically significant positive effect on their positive and negative symptoms and depression levels. As a results; 1) this randomized-controlled trial investigated the effect of physical activity program on positive and negative symptoms depression levels among of patients with schizophrenia, 2) results of this study on 60 patients with schizophrenia showed that an 12-week group physical activity program was significantly effective in patients with schizophrenia’ positive and negative symptoms depression, 3) physical activity should be routinely included in plans of psychiatric nursing care.

Keywords

• Chronic psychiatric patients,depression,physical activity

References

1. Aydemir Ö, Danacı A, Deveci A. Calgary Sizofrenide Depresyon Ölçeği’nin Türkçe versiyonunun güvenilirliği ve geçerliliği. Nöropsikiyatri Arsivi, 2000; 37: 82-86. (in Turkish).
2. Bassilios B, Judd F, Pattison P, Nicholas A, Moeller-Saxone K. Predictors of exercise in individuals with schizophrenia: A test of the transtheoretical model of behavior change. Clinical Schizophrenia and Related Psychoses, 2015; 8: 173–182A.
3. Beebe LH, Tian L, Morris N, Goodwin A, Allen SS, Kuldau J. Effects of consequence, or trans-diagnostic issue?. Schizophrenia Bulletin, 2005; 43(2): 240-244.
4. Bredin SSD, Darren ERW, Donna JL. The health benefits and challenges of exercise training in persons living with schizophrenia: a pilot study. Brain sciences, (2013); 2(3): 821-848.
5. Cankorur VS. Ruhsal Bozukluklar ve Fiziksel Aktivite: Depresyon, Anksiyete Bozuklukları, Affektif Bozukluklar, Yeme Bozuklukları, Madde Kullanım Bozuklukları ve Sizofreni, Korunma ve Tedavide Fiziksel Aktivitenin Rolü. Turkiye Klinikleri Journal of Sports Medicine-Special Topics, 2016; 2(2): 20-26. (in Turkish).
6. Chen LJ, Steptoe A, Chung MS, Ku PW. Association between actigraphyderived physical activity and cognitive performance in patients with schizophrenia. Psychological Medicine, 2016; 46(11): 2375-2384.
7. Cullen C, McCann E. Exploring the role of physical activity for people diagnosed with serious mental illness in Ireland. Journal of psychiatric and mental health nursing, 2015; 22(1): 58-64.
8. Dauwan M, Begemann MJ, Heringa SM, Sommer IE. Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin, 2016; 42(3): 588-599.

9. Edward K, Rasmussen, Munro L. Nursing care of clients treated with atypical antipsychotics who have a risk of developing metabolic instability and/or type 2 diabetes. Archives of Psychiatric Nursing, 2010; 24(1): 46–53.
10. Erkoç S, Arkonaç O, Ataklı C. Negatif semptomlari değerlendirme ölçeğinin güvenilirliği ve geçerliliği. Düsünen Adam, 1991; 4: 20-24. (in Turkish).
11. Falkai P, Malchow B, Wobrock T, Gruber O, Schmitt, A, Honer WG, Cannon TD. The effect of aerobic exercise on cortical architecture in patients with chronic schizophrenia: a randomized controlled MRI study. European Archives of Psychiatry and Clinical Neuroscience, 2013; 263(6): 469-473.
12. Farholm A, Sørensen M. Motivation for physical activity and exercise in severe mental illness: A systematic review of cross‐sectional studies. International Journal Of Mental Health Nursing, 2016; 25(2): 116-126.
13. Faulkner G, Biddle S. Mental health nursing and the promotion of physical activity. Journal of Psychiatric and Mental Health Nursing, 2002; 9(6): 659-665.
14. Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and metaanalysis of exercise interventions in schizophrenia patients. Psychological Medicine, 2015; 45(07): 1343-1361.
15. Fogarty M, Happell B. Exploring the benefits of an exercise program for people with schizophrenia: a qualitative study. Issues in Mental Health Nursing, 2005; 26(3): 341-351.
16. Forsberg KA, Björkman T, Sandman PO, Sandlund M. Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence. Journal of Clinical Nursing, 2010; 19(11‐12): 1519- 1528.
17. Fraser SJ, Brown WJ, Whiteford HA, Burton NW. Impact of nurse‐led behavioural counselling to improve metabolic health and physical activity among adults with mental illness. International Journal of Mental Health Nursing, doi: 10.1111/inm.12343 (2017).
18. Happell B, Platania‐Phung C, Scott D. Placing physical activity in mental health care: A leadership role for mental health nurses. International Journal of Mental Health Nursing, 2011; 20(5): 310-318.
19. Happell B, Scott D, Platania-Phung C, Nankivell J. Nurses' views on physical activity for people with serious mental illness. Mental Health and Physical Activity, 2012; 5(1): 4-12.
20. Hausmann A, Fleischhacker WW. Differential diagnosis of depressed mood in patients with schizophrenia: a diagnostic algorithm based on a review. Acta Psychiatrica Scandinavica, 2002; 106(2): 83-96.
21. Heggelund J, Morken G, Helgerud J, Nilsberg GE, Hoff J. Therapeutic effects of maximal strength training on walking efficiency in patients with schizophrenia – a pilot study. Consequence, or trans-diagnostic issue? Schizophrenia Bulletin, 2012; 43(2): 240-244.
22. Heggelund J, Nilsberg GE, Hoff J, Morken G, Helgerud J.Effects of high aerobic intensity training in patients with schizophrenia: a controlled trial. Nordic Journal of Psychiatry, 2011; 65: 269–275.
23. Lawlor DA, Hopker SW. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ, 2001; 322(7289): 763.
24. Leutwyler H, Hubbard EM, Jeste DV, Miller B, Vinogradov S. Associations of schizophrenia symptoms and neurocognition with physical activity in older adults with schizophrenia. Biological Research for Nursing, 2014; 16(1): 23-30.
25. Lök S, Lök N. Kronik Psikiyatri Hastalarına Uygulanan Fiziksel Egsersiz Programlarının Etkinliği: Sistematik Derleme. Current Approaches in Psychiatry/Psikiyatride Guncel Yaklasimlar, 2016; 8(4): 354-366.
26. Mason OJ, Holt R. Mental health and physical activity interventions: a review of training in persons living with schizophrenia: a pilot study. Brain Sciences 2012; 3: 821–848.
27. Öyekçin, DG. Bir grup sizofreni ve sizoaffektif bozukluk hastasında metabolik sendrom sıklığı. Anadolu Psikiyatri Dergisi, 2009; 10(1): 26-33.
28. Poulin MJ, Chaput JP, Simard V, Vincent P, Bernier J, Gauthier Y, Lanctot G, Saindon J, Vincent A, Gagnon S, Tremblay A. Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme. Australian & New Zealand Journal of Psychiatry, 2007; 41: 980–989.
29. Richardson CR, Faulkner G, McDevitt J, Skrinar GS, Hutchinson DS, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatric Services, 2005; 56(3): 324-331.
30. Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of Clinical Psychiatry, 2014; 75(9): 964-974.
31. Saunders JC. Families living with severe mental illness: A literature review. Issues in Mental Health Nursing, 2003; 24(2): 175-198.
32. Scheewe TW, Backx FJG, Takken T, Jörg F, Strater AV, Kroes AG, Cahn W. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatrica Scandinavica, 2013; 127(6): 464-473.
33. Siris SG, Addington D, Azorin JM, Fallon IRH, Gerlach J, Hirsch SR. Depression in Schizophrenia: Recognition and Management in the USA. Schizophrenia Research, 2001; 47(2-3): 185-197.
34. Soundy A, Wampers M, Probst M, De Hert M, Stubbs B, Vancampfort D, Ströhle A. Physical activity and sedentary behaviour in outpatients with schizophrenia: A systematic review and meta-analysis. International Journal of Therapy & Rehabilitation, 2013; 20(12): 588-596.
35. Stanton R. Happell B, Reaburn P. The mental health benefits of regular physical activity, and its role in preventing future depressive illness. Nursing: Research and Reviews, 2014; 4: 45-53.
36. Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: cause, the qualitative literature. Journal of Mental Health, 2017; 21(3): 274-284.
37. Vancampfort D, Probs 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 Psychiatrica Scandinavica, 2012; 125(5): 382-387.
38. Vancampfort D, Sweers K, Probst M, Maurissen K, Knapen J, Minguet P, De Hert M. Association of the metabolic syndrome with physical activity performance in patients with schizophrenia. Diabetes & Metabolism, 2011; 37(4): 318-323.
39. Zhu S, St-Onge MP, Heshka S, Heymsfield SB. Lifestyle behaviors associated with lower risk of having the metabolic syndrome. Metabolism, 2004; 53(11): 1503-1511.