International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia

• Published in: Disability and rehabilitation 2012-01, Vol.34 (1), p.1-12
• Main Authors: Vancampfort, Davy, De Hert, Marc, Skjerven, Liv Helvik, Gyllensten, Amanda Lundvik, Parker, Anne, Mulders, Nathalie, Nyboe, Lene, Spencer, Felicity, Probst, Michel
• Format: Article
• Language: English
• Subjects: Annan medicin och hälsovetenskap; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Consensus; Disability Evaluation; guidelines; Health; Health care; Health Promotion - methods; Health Services Accessibility; Humans; Life Style; Lifestyle; Medical and Health Sciences; Medicin och hälsovetenskap; Motor Activity; Organizations; Other Medical Sciences; Other Medical Sciences not elsewhere specified; Physical activity; physiotherapy; Rehabilitation; Risk Factors; Schizophrenia; Schizophrenia - complications; Schizophrenia - drug therapy; Övrig annan medicin och hälsovetenskap
• ISSN: 0963-8288; 1464-5165
• DOI: 10.3109/09638288.2011.587090

Purpose: The excess cardiovascular morbidity associated with schizophrenia is attributed to an interplay between behavioural (physical inactivity, unhealthy diet, substance abuse), genetic and illness related factors, as well as the effects of antipsychotic treatment. Patients have limited access to physical healthcare with less opportunity for cardiovascular risk prevention and treatment programmes than the non-psychiatric population. The aim of this paper is to improve physical activity (PA) within rehabilitation programmes for people with schizophrenia. Method: The development process consisted of: a) systematic literature review on PA in schizophrenia in eight databases up to May 2010; b) review on existing national and international guidelines; c) consensus meetings, and d) formulation of the final consensus document. Results: There is insufficient evidence for the relative contribution of PA reducing cardio-metabolic risks in people with schizophrenia. Demographical, biological, psychological, cognitive-behavioural, emotional, social and environmental barriers for PA could be identified. Conclusions: Although PA outcomes on cardio-metabolic parameters are still unknown, the benefits of physical activity as part of a larger lifestyle programme are sufficient for the recommendation that persons with schizophrenia follow the 2008 U.S. Department of Health and Human Services PA Guidelines with specific adaptations based on disease and treatment-related adverse effects. Implications for Rehabilitation For substantial health benefits, patients with schizophrenia should do at least 150 min a week of moderate-intensity, or 75 min of moderate- to vigorous-intensity aerobic activity. The promotion of a healthy lifestyle should be the shared responsibility of all health care providers under supervision of general practitioners and psychiatrists. Each patient with schizophrenia should have access to high quality physical health services with a high quality physical assessment and follow-up. The choice between the two equally effective training alternatives should be based on the patients' preference, and availability of equipment and resources. Health care providers should consider illness symptoms, side-effects of antipsychotic medication, low self-efficacy and the lack of social support when motivating patients to a healthy lifestyle.