Multimodal Physical Therapy Program in Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      The aim of the investigators' study would evaluate the effectiveness of a multimodal exercise
      program on physical fitness, physical activity level and clinical symptomatology in patients
      with schizophrenia.

      DESIGN: Randomized controlled trial. SUBJECTS OF THE STUDY: People with schizophrenia who
      receiving treatment in Regional Hospital of Malaga. INTERVENTION: DATA ANALYSIS: descriptive
      statistics, measuring central tendency and dispersion of the variables study. Inferential
      statistics will be made between intervention of key variables and outcome.
    

Detailed description: 
      It´s well known that life expectancy of people with severe mental disorders is approximately
      from 15 to 20 years less compared with general population. The higher mortality risk in this
      population group reflects a combination of factors: a) increased prevalence of comorbid
      medical conditions; b) adverse effects of pharmacological treatment; c) higher rates of
      suicide, accidental and other violent death; d) poorer access to physical healthcare than for
      the general population. In addition, this vulnerable population has an extremely high
      prevalence of obesity, nearly twice that of the overall population. Therefore, it is not
      surprising that persons with serious mental illness have an increased occurrence of
      weight-related conditions, including heightened risk of diabetes mellitus, hypertension, and
      dyslipidaemia; in addiction to this, these pathologies are under-diagnosed and under-treated.
      Environmental issues and unhealthy lifestyle can account for all these conditions,
      particularly in people with SMI, such as high levels of cigarette smoking, unhealthy diet or
      sedentary life style. Tendency to isolation and a reduced social network are often obstacles
      to the practice of physical exercise.

      In addition, antipsychotics, in particular atypical antipsychotics, have been associated with
      weight gain, dyslipidaemia, diabetes, and other cardiac risk factors. Furthermore, the side
      effects of these medications are one of the most significant barriers to changing their
      lifestyle.

      Finally, the stigma associated with mental illness may also contribute to low levels of
      participation in mainstream leisure-time physical activities.

      Regular practise of physical exercise improves physical and mental health in the general
      population. A recent systematic review of physical activity and schizophrenia has shown
      improvement in both positive and negative symptoms, and a general increase in wellbeing of
      people with schizophrenia. In addition to cardiac and metabolic effects, physical exercise
      has demonstrated an improvement in both depression and anxiety.

      The main objective of this study is to evaluate the effectiveness of a multimodal physical
      activity programme in physical fitness and physical activity level in persons with a
      diagnosis of schizophrenia.

      Secondary objectives are: Evaluate the effect of this intervention in clinical
      symptomatology; Analyse the effect of this programme in motivating these persons to undertake
      physical activity; Identify the effect of the program on the physical fitness of the
      subjects; Evaluate any influence of the program on the self-perception of stigma in the
      subjects; Evaluate any variation of level of physical activity before and after the study in
      the subjects; Measure the impact on the quality of life of people who participate in this
      study; Perform a cost-effectiveness analysis of the program.

      The present study is a randomized clinical trial to compare the effect of a multimodal,
      individualized, physical programme of muscular strength, endurance, aerobic training and
      health education against a control group.

      All variables will be measured at the beginning and the end of the 12-week program by the
      same evaluator, whose group of subjects will be randomly allocated to the trial group and
      control group without their knowledge. Furthermore, the variables will be measured 9 months
      after the end of the program. Subjects allocated to the control group will have all the same
      variables measured, and will be given the option to participate in the program once the study
      is completed.
    

Intervention name(s): A multimodal physiotherapy programme
Intervention type(s): Other
Intervention description(s): Intervention: individualised Multimodal Physiotherapy Programme of therapeutic exercises with education healthy-style-of-life based.
Groupal sessions two times per week during 12 weeks. Each session 60 minutes: 10 minutes of warm up, 20 minutes of strength and muscular endurance, 20 minuts of aerobic training, 10 minutes of cold-down.
Intensity aerobic training: The training heart rate will be calculated according to recommendations of the American College of Sport Medicine (ACSM), it must oscillate between 55/65% and 90% of the HRmax. Initial four weeks: moderate intensity (55-69% HRmax); Following weeks according to each response, to higher level of training (70-89% HRmax). Strength training: individualised working with the principal muscular groups. 3 sessions using a weight which can repeat the exercise 10-15 times, increasing to a weight at which they can repeat the exercise 8-12 times.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Schizophrenia; Mental Health; Physical Therapy; Quality of life; Stigma; Positive and negative symptoms; Physical fitness; Physical activity