Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia
Introduction
With the emergence of more effective pharmacologic treatment of psychiatric symptoms in schizophrenia, increasing attention has been paid to the development of interventions targeting long-term functional and subjective outcomes, which remain poor for many patients with schizophrenia (van Os and Kapur, 2009). Health related quality of life (HRQL) is a measure of the impact of an illness and consequent treatment upon functional health status and well-being as perceived by the patient (Fontaine and Barofsky, 2001). In patients with schizophrenia symptoms (Eack and Newhill, 2007), a higher BMI (Allison et al., 2003, Strassnig et al., 2003, De Hert et al., 2006a, Faulkner et al., 2007, Kolotkin et al., 2008), waist circumference (Faulkner et al., 2007) and subjective side-effects of antipsychotic medication (Bebbington et al., 2009) need to be considered in relation to their impact on HRQL. Also a poor social network, stigma (Sibitz et al., 2010) and neuropsychological measures including verbal ability, attention, working memory and problem-solving (Kurtz and Tolman, 2011) and smoking severity (Dixon et al., 2007) are known to be related to impairments in HRQL.
Previous research in the general population demonstrated that a sedentary lifestyle and a reduced functional exercise capacity impair HRQL (Hulens et al., 2002). This might be due to several physical limitations including musculoskeletal pain in the lower limbs and a reduced cardiovascular fitness (Hulens et al., 2003). In the same way, several studies indicate that the presence of metabolic syndrome (MetS) is associated with impaired HRQL (Ford and Li, 2008, Miettola et al., 2008), albeit data are inconsistent and limited by failure to adjust for obesity (Vetter et al., 2010). It is known that in high-risk groups MetS is associated with a lower physical activity participation and reduced functional exercise capacity (Gardner et al., 2006, Vancampfort and al., in press). One of the putative mechanisms for this association might be that MetS diminishes the peripheral circulation in the lower limbs (Gardner and Montgomery, 2008). Poor peripheral circulation limits physical activity participation (Chen et al., 2001) creating a vicious circle of sedentary behavior, worsening of cardiometabolic parameters and progressive decline in function and deconditioning (Whaley et al., 1999), which on its turn might impair HRQL.
Although the majority of schizophrenia patients are known to be sedentary (Faulkner et al., 2006, Lindamer et al., 2008) and to have a reduced functional exercise capacity (Vancampfort et al., 2011) and that MetS is highly prevalent in schizophrenia (De Hert et al., 2009, Mitchell and al., submitted for publication), it is currently unknown whether these parameters also contribute to a HRQL impairment.
The primary aim of the present study therefore was to identify if lack of physical activity participation and an impaired functional exercise capacity compared with healthy controls might contribute to an impaired HRQL in patients with schizophrenia. A secondary aim was to identify if within patients with schizophrenia also the presence of MetS might also explain the variability in HRQL.
Section snippets
Participants and setting
Over an 8-month period, hospitalized patients with a clinical diagnosis of schizophrenia of the University Psychiatric Centre, Catholic University Leuven, campus Kortenberg in Belgium were invited to participate in the study. Diagnosis based on DSM-IV criteria was established by experienced psychiatrists responsible for the patients' treatment. No formal semi-structured diagnostic interview was performed. Patients were excluded if they had a DSM-IV diagnosis of substance dependence or a change
Participants
A total of 78 patients with schizophrenia were initially recruited. Seven persons with a DSM-IV diagnosis of substance dependence were excluded. Two patients were excluded for a cardiovascular or neuromuscular disorder that could prevent safe participation. Of the 69 recruited patients, another seven declined to participate (six were not interested and one could not be motivated to walk for 6 min). Reasons for additional drop-out were transfer to another hospital in the testing phase (n = 1) and
Discussion
To our knowledge the present study is the first to demonstrate that in patients with schizophrenia, a reduced physical activity participation during leisure time compared with age- and gender-matched healthy controls contributes to an impaired physical HRQL. Low HRQL has been consistently reported in schizophrenia (Sullivan et al., 1989, Allison et al., 2003, Strassnig et al., 2003, Hofer et al., 2004, Faulkner et al., 2007, Kolotkin et al., 2008, Folsom et al., 2009), but present data offer
Role of funding source
None.
Contributors
The study was designed by D. Vancampfort and M. De Hert. All data were collected by K. Sweers, K. Maurissen and J. Knapen. Statistical analyses were performed by D. Vancampfort and M. Probst. D. Vancampfort, M. De Hert and T. Scheewe wrote the first draft of the paper, and all other co-authors commented and contributed to the subsequent revisions. All authors have approved the final manuscript.
Conflict of interest
Dr. M. De Hert has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory boards of AstraZeneca, Lundbeck JA, Janssen-Cilag, Eli Lilly, Pfizer, Sanofi and Bristol-Myers Squibb. D. Vancampfort, Dr. M. Probst, T. Scheewe, K. Maurissen, K. Sweers and Dr. J. Knapen declare that they have no conflicts of interest.
Acknowledgments
None.
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2018, Psychiatry ResearchCitation Excerpt :In the same study, self-esteem was also identified as a predictor of QoL. On clinical variables, the association between BMI and QoL domains in the literature is inconsistent, the majority of previous studies reported that overweight and/or higher BMI was associated with impairments in the physical aspects of QoL (Bressington et al., 2016; Faulkner et al., 2007; Vancampfort et al., 2011). Other studies (Kolotkin et al., 2008; Sugawara et al., 2013), reported that both physical and psychological aspects of QoL were significantly and positively associated with an overweight status in this population.