# Exercise as it relates to Disease/Can exercise reduce coronary heart disease in patients with Schizophrenia?

This is an analysis of the journal article 'Effects of Exercise Therapy on Cardiorespiratory Fitness in Patients with Schizophrenia', by Thomas W. Scheewe et al.

## What is the background to this research?

Increased mortality in schizophrenia is caused largely by Coronary Heart Disease and is more likely to predict mortality from coronary heart disease then diabetes or smoking hypertension This study both compares cardiorespiratory fitness in patients with schizophrenia and matched healthy controls as well examining the effects of exercise therapy on schizophrenia patients and a control groups cardiorespiratory fitness. Evidence is growing that poor cardiorespiratory fitness is a key risk factor for the development of coronary heart disease in patients with schizophrenia

## Where is the research from?

The researchers involved in this study are from many Utrecht in the Netherlands. This research recruited subjects from the University Medical Center, Utrecht and regional mental health care institutes.

## What kind of research was this?

This quantitative research is a randomized clinical trial focusing on the link between cardiorespiratory fitness and chronic heart disease with a focus on patients diagnosed with schizophrenia.

## What did the research involve?

63 patients diagnosed with schizophrenia and 55 healthy comparisons that were matched for gender, age and socioeconomic status took part in the study between May 2007 and May 2010. The schizophrenia patients were assigned to exercise or occupational therapy and the control group was assigned exercise or life as usual for a 6-month period.
Cardiorespiratory fitness was assessed at the beginning and end of the study with a cardiopulmonary exercise test on a cycle ergometer. This test was terminated when the person was unable to continue due to exhaustion or conforms criteria. The cardiorespiratory fitness was defined as the highest relative (mL.min-1.kg-1) mean oxygen uptake at any 30-s interval during the test (V ˙ O2peak) and the peak work rate at the moment of exhaustion (Wpeak). Blood pressure was measured at rest before beginning the exercise by having the person lay on the ground before doing so and just before cessation of the cardiopulmonary exercise test.

## What were the basic results?

The patients who completed exercise therapy showed an increase in their relative VO2 peak, whereas patients who undertook the occupational therapy showed a decrease in their relative VO2peak. The control group showed an increase to their relative VO2peak in both the exercise therapy group and ‘life as usual’ group although the ‘life as usual’ groups increase was at a much lesser extent for the other groups. The study also showed an increase to Wpeak in both the patients and control group completing exercise therapy whilst the occupation therapy patients and ‘life as usual’ controls decreased.

## What conclusions can we take from this research?

Exercise therapy is an effective way to increase a person’s cardiorespiratory fitness resulting in a decreased chance of coronary heart disease in patients with schizophrenia and the matched healthy controls. When working with a patient diagnosed with schizophrenia it is important to recognise the individuals needs as seen in the study with one patient who did not complete the breath analyses as the breathing apparatus would trigger an anxiety response.
Throughout the study there it was stated that the patients smoke significantly more cigarettes per day then the control group which could also be a cause of the high mortality rate within the group affecting cardiorespiratory fitness and in response coronary heart disease. I believe this spark’s further investigation on the role cigarettes might play on the patients. Exercise therapy also had a lower rate of patients dropping out in comparison to the occupational therapy

## Practical advice

By implemented an exercise routine of just 1 to 2 hours a week over a 6-month period is enough to trigger a positive response to a person’s cardiorespiratory fitness. Exercise therapy is a proven way to promote a healthy lifestyle while decreasing the chance of coronary heart disease. Addressing the amount of cigarette, a patient smokes a day should also be addressed as it has a negative effect on a person’s body and cardiorespiratory fitness.

## Further information/resources

For further information or resources click on the links below.
* What is Schizophrenia?: https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
* What is Coronary Heart Disease?: https://www.nhlbi.nih.gov/health/health-topics/topics/cad/
* Cardiorespiratory fitness and its link to mortality: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951585/

## References

* 1 2 3 Scheewe, Thomas & Takken, T & S Kahn, René & Cahn, Wiepke & Backx, F. (2012). Effects of Exercise Therapy on Cardiorespiratory Fitness in Patients with Schizophrenia. Medicine and science in sports and exercise. 44. 1834-42. 10.1249/MSS.0b013e318258e120.
* ↑ Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as aquantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.
* ↑ Deimel H, Lohmann S. Physical capacity of schizophrenic patients. Rehabilitation. 1983;22(2):81–5.
* ↑ Gretchen-Doorly D, Kite RE, Subotnik KL, et al. Cardiorespira-tory endurance, muscular flexibility and strength in first-episodeschizophrenia patients: use of a standardized fitness assessment. Early Interv Psychiatry. 2011; doi: 10.1111/j.1751-7893.2011.00313
* ↑ Heggelund J, Hoff J, Helgerud J, Nilsberg GE, Morken G. Re-duced peak oxygen uptake and implications for cardiovascular health and quality of life in patients with schizophrenia. BMC Psychiatry. 2011;11(1):188.
* ↑ Strassnig M, Brar JS, Ganguli R. Low cardiorespiratory fitness and physical functional capacity in obese patients with schizophrenia. Schizophr Res. 2011;126(1–3):103–9.
* ↑ Wildgust HJ, Beary M. Are there modifiable risk factors whichwill reduce the excess mortality in schizophrenia? J Psycho- pharmacol. 2010;24(Suppl 4):37–50.
* ↑ American Thoracic Society/American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–77.
* ↑ Astorino TA. Alterations in VOmax and the VO plateau with manipulation of sampling interval. Clin Physiol Funct Imaging. 2009;29(1):60–7..
* ↑ de Leon J, Diaz FJ. A meta-analysis of worldwide studies demon-strates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res. 2005;76(2–3):135–57.