Elsevier

Schizophrenia Research

Volume 201, November 2018, Pages 98-104
Schizophrenia Research

Physical activity pattern and cardiorespiratory fitness in individuals with schizophrenia compared with a population-based sample

https://doi.org/10.1016/j.schres.2018.05.038Get rights and content

Abstract

Objective

Thorough description of objectively assessed physical activity (PA) and sedentary time in people with schizophrenia is lacking, and previous studies comparing PA and cardiorespiratory fitness levels with healthy controls are limited by their small sample size and/or poor methodology.

Method

PA, sedentary behavior, and cardiorespiratory fitness level were assessed in 67 adults diagnosed with schizophrenia (EPHAPS study) and compared with a population-based sample of 2809 adults (NPASS study).

Results

Fifty-five percent of the participants with schizophrenia had the unhealthy combination of not meeting the PA recommendations and sitting >7.5 h per day compared to 32% in the population-based sample. The PA level was especially low on weekday afternoons and evenings and throughout most of the day on weekends. The peak oxygen uptake for EPHAPS women was on average 23% lower than that for NPASS women, while EPHAPS men achieved on average 34% lower oxygen uptake on the exercise test compared with NPASS men.

Conclusion

People with schizophrenia are significantly less physically active, more sedentary, and have a poorer cardiorespiratory fitness level compared with the general population. Tailor-made PA interventions for people with schizophrenia should target their PA and sedentary behavior on afternoons and weekends especially.

Introduction

People with schizophrenia have mortality rates 2–3 times higher than the general population, equating to a mortality gap of 10–20 years (Saha et al., 2007). This heightened mortality risk can be partly explained by the high prevalence of noncommunicable diseases such as cardiovascular diseases (CVD) (Capasso et al., 2008) and type 2 diabetes (T2D) (Vancampfort et al., 2016). The reasons for this increased risk of CVD and T2D among patients with schizophrenia are likely to be a complex interplay between many factors, such as genetic disposition (Andreassen et al., 2013), adverse effects of antipsychotic medication (Mitchell et al., 2013; Wu et al., 2015), and health inequalities (De Hert et al., 2011; Mitchell et al., 2009). Moreover, an observed low physical activity (PA) level (Stubbs et al., 2016), high amount of time spent in sedentary behavior (defined as any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents, while in a sitting, reclining, or lying posture (Tremblay et al., 2017)) (Janney et al., 2013), and low cardiorespiratory fitness (CRF) level (Vancampfort et al., 2015) have been recognized as potentially crucial factors (Mitchell et al., 2009; Ratliff et al., 2012; Vancampfort et al., 2013).

Although some studies have reported on PA level (Soundy et al., 2013) and time spent sedentary (Janney et al., 2013) with the use of accelerometers in people with schizophrenia, the full potential of the device to describe PA and sedentary patterns in detail has not been explored. Important aspects of accelerometer PA and sedentary data, such as weekend vs. weekday and time of day (hour-by-hour) have not yet been described in persons with schizophrenia. By including these data we can obtain more comprehensive PA and sedentary profiles that highlight critical opportunities for intervention. Furthermore, comparison of the data with a population-based sample ensures that epoch lengths (sample time), nonwear definitions, and cutoff points for intensity are harmonized, providing a solid basis to investigate how physically active and sedentary patients with schizophrenia really are, and in what way (if any) their PA and sedentary profiles differ from the general population. The few studies that have compared PA (Soundy et al., 2013; Stubbs et al., 2016) and CRF (Kimhy et al., 2014; Ostermann et al., 2013; Ozbulut et al., 2013; Strassnig et al., 2011; Vancampfort et al., 2015) levels with healthy controls are, except for one Dutch study (Scheewe et al., 2012), limited by their small sample size and/or poor measurement methods, and none have compared their results to a national representative sample. In short, a more detailed picture of the PA and sedentary patterns in this vulnerable population would assist clinicians and others in how best to help patients with schizophrenia become more physically active and less sedentary, and thereby reduce the burden of noncommunicable diseases and presumably improve quality of life.

Thus, the aim of this study was to provide a detailed description of the PA pattern, sedentary behavior, and cardiorespiratory fitness level in a sample of outpatients with schizophrenia and to compare these with a population-based sample.

Section snippets

Design

This study is based on baseline data from the Effects of Physical Activity in Psychosis study (EPHAPS) (ClinicalTrials.gov, registration number NCT02205684) and the Norwegian Physical Activity Surveillance Survey (NPASS). Both studies were approved by the Regional Ethics Committee for Medical Research (EPHAPS; 2014/372, NPASS; S-08046b). The methods used in EPHAPS and NPASS have been described in detail elsewhere (Edvardsen et al., 2013; Engh et al., 2015; Hansen et al., 2012). Briefly, the

Results

The participants wore the monitor for an average (±standard deviation (SD)) of 3.3 ± 0.8 days (EPHAPS) and 6.4 ± 0.9 days (NPASS). The mean wearing time was 12.9 ± 1.4 h·day−1 and 14.8 ± 1.1 h·day−1 for the EPHAPS and NPASS participants, respectively.

Table 1 displays the relevant demographic information for both groups. The EPHAPS population of patients with schizophrenia was significantly younger, heavier, less educated, and far fewer were employed and married. Except for one patient, all

Discussion

The patients with schizophrenia performed less MVPA and spent more time sedentary compared with the NPASS population-based sample, on both weekdays and at weekends. Interestingly, while the NPASS participants were more active and less sedentary on weekends compared with weekdays, no such increment was found for the EPHAPS group. The PA level of EPHAPS participants was especially low in the afternoons and evenings during weekdays and throughout most of the day on weekends compared with the NPASS

Acknowledgments

The authors would like to give thanks to all participants from EPHAPS and NPASS. The authors also thanks Ole-Jakob Bredrup, Helge Bjune, Jan-Freddy Hovland, Bjørn-Einar Oscarsen, Camilla Lahn-Johannessen and Ellen Gurine Færvik for conducting the measurements. EPHAPS received funding from Vestfold Hospital Trust, Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds, Norwegian Research network in Severe Mental Illness (NORSMI), NORMENT/KG Jebsen Centre for Psychosis

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