# Exercise as it relates to Disease/Exercise and its effects on Schizophrenia
## Exercise and its effects on schizophrenia

Schizophrenia is a destructive mental illness that affects the brains ability to understand what is real and what is not. It is mental disease that affects approximately 1% of the world’s population. The term schizophrenia means "split mind" where the person thought process and emotional response are not connected.The disease schizophrenia was first used in 1911 by a swiss man named Dr Eugen Bleuler to diagnose patients. There are a variety of types of schizophrenia such as
1- Paranoid-Type schizophrenia; delusions of conspiracy and or delusions of persecution. Can also have auditory hallucinations. 2- Disorganised-Type: Unorganised thought processes, speech and behavior. This particular type of schizophrenia contains the flat effect. 3- Catatonic-Type: extremes in behavior such as hyperactivity to extreme lethargic and immobility. 4- Undifferentiated-Type: This category is for symptoms that do not fall into the other classifications of schizophrenia. 5- Residual-Type: When patients symptoms become less or diminish.
Further information about types of Schizophrenia cane be found here: Types of Schizophrenia or Understanding Schizophrenia

## Causes

This disease can be caused by a number of things such as;
* Genetics
* Environmental factors such as stress
* Drug abuse

## Treatment

Current methods of treating patients with schizophrenia are ;
* Cognitive behavioral therapy(CBT)
* Medications such as Anti-psychotics
* Case management
Getting help is crucial in helping schizophrenic patients gain control of their lives. Such help is found at the APS Australian Psychology Schizophrenia contact. Here they can help find the closest psychologist that specialises in treatment or help of schizophrenic patients. Further information about schizophrenia and its physiological effects of patients can be found in the following links;

## Exercise and Schizophrenia

Physical activity has had many benefits in helping schizophrenia patients. Besides the obvious benefits of exercise such as weight loss, decreased blood pressure, lower risk of cardiovascular disease, increase aerobic fitness and muscle mass gains there are more disease specific adaptions from exercise for schizophrenia patients (refer to figure 1). The following link gives some information as to why exercise may be good for people with schizophrenia.

## Statistical Evidence

A study by Vancampfort, 2010 has shown that physical activity has also had significant effects in cardiovascular and metabolic parameters {Vancampfort, 2010 #205}. Some studies have shown that when implementing physical activity for schizophrenics that exercise is associated with less depressive symptoms. This also works visa versa that with less depressive symptoms comes a stronger adherence to exercise {Marzolini, 2009 #206}. It has been shown through numerous studies that exercise has a positive effect on negative symptoms and depressive states/psychiatric states {Acil, 2008 #214} {Behere, 2011 #211} {Gorczynski, 2010 #225}.
Particular types of exercise have been found to be more beneficial for patients with schizophrenia. Yoga has been found to have a better outcome for mental state and significantly better quality of life scoring {Gorczynski, 2010 #225}. It has also had less psychopathology. Through this schizophrenia patients have had better occupational functioning and improved quality of life {Duraiswamy, 2007 #210} {Behere, 2011 #211}. Yoga and aerobic exercise have also been shown to decrease anxiety levels and psychological stress {Behere, 2011 #212}. The difference in the effect of aerobic exercise or yoga sessions doesn’t seem to have a significant difference in effect on schizophrenia patients {Behere, 2011 #212}.
Other adaptions that have been found in schizophrenia patients are an increase in hippocampal volume. This has been associated with an increase in the N-acetylaspartate to creatine ratio in the hippocampus. This same study also found that there was a better recall of short term memory after the aerobic exercise intervention {Pajonk, 2010 #208}. Refer to Figure 1 for a summary of exercise effects on schizophrenia.
Aside from less depressive symptoms and psychiatric states exercise in general is a great social outing for patients {Vancampfort, 2010 #205. Depending on the living status of a patient whether they are in hospital, psychiatric ward or prison exercise acts as a support group where they can help each other and talk to each their about current issues or struggles. Exercise groups can also help people engage in social practice and develop people skills.
| Exercise effects non specific to Schizophrenia | Exercise effects specific to Schizophrenia |
| Increased muscle mass | Decreased depressive symptoms |
| Increase VO2max | Decreased psychopathy |
| Increased aerobic ability | Decreased negative symptoms |
| Decreased risk of CV | Increased quality of life |
| Weight loss | Increased positive states |
| Decreased blood pressure | Decreased psychological stress |
| Example | Decrease anxiety |
Figure 1- Represents a comparison of general exercise effects that would be expected and exercise effects that are more specific to the nature of schizophrenia.

## Summary

In summary of all studies and experiments it becomes apparent that the mild to moderate physical activities have a more of a beneficial effect on mental states, physical attributes, psychiatric states and quality of life more so than high intensity activities over a 2-3 month period. In saying this exercise is not a cure to schizophrenia however it does reduce the symptoms of schizophrenia. There is very limited research into high intensity anaerobic exercise to compare results to so currently Yoga and aerobic exercise is the only available literature. It is uncertain whether this is a short-term fix or whether a long term effect on patients.
Further research is needed over longer periods of time to apply a specific exercise prescription to schizophrenia patients.

## References;

1.Vancampfort, D., M.Probst, et al.(2011). "Lack of Physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia." Schizophrenia Research 129(122-127)
2.Holley, J., D.Crone, et al. (2001). " The effects of physical activity on psychological well-being for those with schizophrenia: A systematic review." British Journal of Clinical Psychology 50 (1) :84-105
3.Acil, A. A., S.Dogan, et al .(2008). " The effects of physical activity and quality of life in patients with schizophrenia." Journal of Psychiatric and Mental Health Nursing 15 (10): 808-815
4.Vancampfort, D., K. Vansteelandt, et al. (2012). "Yoga in schizophrenia : a systematic review of randomised controlled trials." Acta Psychiatrica Scandinavica 126 (1):12-20
5.(2001) . "State anxiety, psychological stress and positive well-being responses to yoga and aerobic exercise in people with schizophrenia:a pilot study." Disability and rehabilitation 33 (8): 684-689.
6.Behere, R.V., R.Arasappa,et al . (2001). " Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia." Acta Psychiatrica Scandinavica 123(2) : 147-153.
7.Duraiswamy, G., J.Thirthalli,et al . (2007). "Yoga therapy as an add-on treatment in the management of patients with schizophrenia-a randomised controlled trial." Acta Psychiatrica Scandinavica 116 (3): 2267-232.
8.(2005). "Exercise effects of mental and physical health parameters of persons with schizophrenia." "Issues in Mental Health Nursing 26(6) : 661-676
9.Pajonk, F., T.Wobrock, et al. (2010). : Hippocampal plasticity in responses to exercise in schizophrenia." Archives of General Psychiatrie 67 (2): 133-143
10.(2005). "exploring the benefits of an exercise program for people with schizophrenia: A qualitative study." Issues in Mental Health Nursing 26 (3) : 341-351.
11.Marzolini, S., B.Jenson, et al .(2009). " Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach." Mental Health and Physical Activity 2(1) : 29-36.
12.Vancampfort, D., J.Knapen, et al (2010). " The therapeutic value of physical exercise for people with schizophrenia." Tijdschrift voor Psychiatrie 52 (8) : 565-574.