Impact of physical activity on functioning of patients with first-episode psychosis — A 6 months prospective longitudinal study

https://doi.org/10.1016/j.schres.2013.08.034Get rights and content

Abstract

There has been increasing interest in studying the impact of physical activity on the psychological and physical well-being and functioning in patients with first-episode psychosis. The exploration of factors which contribute to physical activity in psychosis may open up opportunities for improvement of functional outcome. The purpose of this study was to examine the association between physical activity level and functioning in psychosis. A total of 283 patients with first-episode psychosis were recruited from a specialized early intervention service for adult-onset psychosis (Jockey Club Early Psychosis Project) in Hong Kong. The level of physical activity, sociodemographics and clinical characteristics was assessed at study entry. Functioning was assessed at 6-months period. Ninety-six (33.9%) patients were categorized as physically inactive, and 187 (66.1%) of them were physically active. Being physically inactive (β = 0.163, P = 0.003), having more positive and negative symptoms [SAPS total score (β =  0.161, P = 0.005), and SANS total score (β =  0.202, P = 0.001)], and having lower household income (β = 0.207, P = 0.001) at baseline predicted poorer functioning at 6 months. Early intervention for psychosis should target to improve patients' physical activity level which may help subsequent functioning.

Introduction

Physical inactivity is a major contributor to death and disability from non-communicable diseases including diseases of the heart and vascular system, diabetes mellitus, cancers, and obstructive pulmonary disease (Lee et al., 2012). It has been suggested that physical inactivity is associated with poorer cognitive functioning and increased risk of global cognitive decline (Singh-Manoux et al., 2005, Buchman et al., 2012). Physical activity is also found to be associated with functioning and quality of life in patients with schizophrenia (Martín-Sierra et al., 2011, Vancampfort et al., 2012a). Patients with physical inactivity tend to have higher body mass index and lower exercise capacity (Martín-Sierra et al., 2011, Vancampfort et al., 2011). It has been suggested that the cumulative effect of physical inactivity and antipsychotic use can further increase mortality of patients with schizophrenia (Weinmann et al., 2009). However, most of the previous studies were conducted in chronic patients, little is known regarding the relationship between physical activity and functioning in first-episode psychosis patients.

In this study, we aimed to examine the prevalence of physical inactivity in a large cohort of patients with first-episode psychosis. The impacts of baseline physical activity, clinical symptoms and demographic information were also studied in relation to functioning level at 6 months.

Section snippets

Method

This study was conducted under the Jockey Club Early Psychosis (JCEP) project in Hong Kong (Hui et al., 2013). JCEP is an early intervention service tailored for patients aged between 25 and 55, who had been diagnosed as having psychotic disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, or psychotic disorder not otherwise specified according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental

Results

Patients' physical activity level, demographics and clinical characteristics are summarized in Table 1. According to the IPAQ criteria, 33.9% (n = 96) of the first-episode psychosis patients were classified as physically inactive, and 66.1% (n = 187) were classified as physically active.

We compared the clinical and demographic characteristics of patients who were physically inactive and active. The two groups did not differ in age, education, household income, living condition, existing medical

Discussion

The present study found that 33.9% of the first-episode psychosis patients were physically inactive. Without matched data from the healthy controls, standardized direct comparison could not be made. However, using data published in the census (Centre for Health Protection, 2011), the physical inactivity level was 21.5% in Hong Kong general population, where the rate is lower than that in patients. We also found that physical activity was associated with better functioning in first-episode

Role of funding source

The study was funded by the Hong Kong Jockey Club Charities Trust. The funder had no role in the analysis of data or in the preparation of the manuscript.

Contributors

EHML, CLMH and YKL were involved in the statistical analysis and EHML, CLMH, YKL and JTML were involved in writing of the manuscript. EHML, CLMH, WCC, SKWC, YKL, JTML and EYHC interpreted the data. CLMH and YKL coordinated the study and collected data. EYHC was principal investigator and contributed to all elements of the study. All authors contributed to revision of the paper and have seen and approved the final version.

Conflict of interest

EHML sat on a scientific advisory board for AstraZeneca and Eli Lilly. EYHC sat on a scientific advisory board for Otsuka, received educational grant support from Janssen-Cilag, and research funding from AstraZeneca, Janssen-Cilag, Pfizer, Eli Lilly, Sanofi-Aventis, and Otsuka. All other authors declare that they do not have any conflicts of interest.

Acknowledgments

The authors would like to thank all the patients for participating in the study.

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