Title: Het Metabool Sydroom bij Schizofrenie: Relaties met Fysieke Activiteit, Functionele Oefencapaciteit en de Eurofit Testbatterij
Other Titles: Metabolic Syndrome in Schizophrenia: Relationships with Physical Activity, Functional Exercise Capacity and Eurofit Test Battery Performance
Authors: Vancampfort, Davy
Issue Date: 25-Jan-2012
Abstract: Patients with schizophrenia lose up to 30 years of life expectancy compared to the general population. Although suicide does claim the lives of many of these patients, most of the premature deaths are due to cardiovascular disease. The metabolic syndrome, a concept that brings together a collection of abnormal clinical findings including dysglycemia, increased blood pressure, elevated triglyceride levels, low high-density lipoprotein cholesterol levels and central adiposity, is an important risk factor for cardiovascular disease incidence. Patients with schizophrenia represent a vulnerable group to develop metabolic abnormalities. This doctoral thesis focuses on the importance of sufficient consideration of physical activity participation, sedentary behaviour, the functional exercise capacity and health related physical fitness when developing preventive and treatment programmes for the increased metabolic risk in patients with schizophrenia. In a first meta-analysis in part I of this doctoral thesis (chapter 1) we found that 32.5% of patients with schizophrenia suffer from the metabolic syndrome. Patients with a longer illness duration are at higher risk. The detection, prevention, and treatment of the underlying risk factors of the metabolic syndrome therefore is essential in reducing the cardiovascular disease burden in patients with schizophrenia. In a second meta-analysis (chapter 2), we demonstrated that clinicians still fail to adequately assess the risk of metabolic syndrome risk factors. Routine metabolic screening in daily clinical practice is by no means sufficiently robust to detect the high rates of abnormalities found in this population. A lack of knowledge about existing guidelines and an inconsistency in quality of practice guidelines on screening for metabolic risk could be underlying reasons for the suboptimal monitoring rates (chapter 3). Effective monitoring of metabolic disturbances is not sufficient on its own, as appropriate treatment including lifestyle changes such as being physically active, following a heart healthy diet, and quitting smoking are also important. In this doctoral thesis we focus especially on the importance of considering physical activity participation. It was shown that at the moment the quality of physical activity related clinical practice guidelines in preventing and treating metabolic risk factors in patients with schizophrenia available to health care professionals is overall inconsistent and reasonably low (chapter 4). Detailed clinical practice guidelines on physical activity are urgently needed. There is evidence that physical activity with or without diet counselling is feasible and successful in improving the cardio-metabolic risk profile in patients with schizophrenia (chapter 5). Developing physical activity related prevention and treatment strategies requires a profound knowledge about the modifiable determinants of the metabolic syndrome and about its functional consequences on daily living. In chapter 6 of part I, a framework for physical activity research is introduced that summarised the evidence that, next to the health-related lifestyle status, researchers and health care professionals need to take into account three modifiable factors that affect the prevalence of the metabolic syndrome in patients with schizophrenia: (1) the physical fitness status, (2) the mental health status and (2) the antipsychotic medication use. Designing well-considered treatment programmes for patients with schizophrenia therefore requires a reliable measurement of the functional exercise capacity and health related physical fitness. Part II of this doctoral thesis demonstrates that the 6-minute walk test (chapters 7 and 8) and Eurofit test battery (chapter 9) are reliable field tests. Future validity-studies should examine whether these tests can be used for measuring changes in functional exercise capacity and health related physical fitness. Adapting a physically active lifestyle is a process that involves appreciation of its importance, motivation to plan a change, and acknowledgement of the physical, psychological, social, environmental and policy barriers which need to be addressed in order to increase adherence to the plan. In parts III and IV of this doctoral thesis we show that patients with schizophrenia are at a disadvantage in each step of this process which contributes to an impaired mental and physical health related quality of life (chapter 15). Our research findings posit that overweight and obesity (chapters 10, 12-14), physical pain (chapter 10), low physical self-perception (chapters 10 and 11), cardio-metabolic co-morbidity (chapters 12 and 13), negative, cognitive and depressive symptoms (chapters 9 and 13), side-effects of antipsychotic medication (chapters 8, 9 and 14), no belief in the benefits of being physically active (chapters 16 and 17), lack of knowledge on the health risks of a sedentary lifestyle (chapter 17), and lack of social support (chapter 17) all might influence physical activity behaviour in patients with schizophrenia. Conclusion in this doctoral thesis is made that in order to address the problem of suboptimal physical health treatment for patients with schizophrenia, all the above-mentioned barriers need to be considered. Changes in the health care system in general and the physical activity delivery system in particular are essential (chapters 16-18). Government and health care institutions have to identify and designate patients with schizophrenia as a health disparity population before this problem with high public health relevance can be handled.
Publication status: published
KU Leuven publication type: TH
Appears in Collections:Research Group for Adapted Physical Activity and Psychomotor Rehabilitation
University Centre Sint Jozef (-)
Research Group Psychiatry (-)

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