Abstract: Vancampfort D, Vansteelandt K, Scheewe T, Probst M, Knapen J, De Herdt A, De Hert M. Yoga in schizophrenia: a systematic review of randomised controlled trials. Objective:  The objective of this systematic review was to assess the effectiveness of yoga as a complementary treatment on general psychopathology, positive and negative symptoms and health-related quality of life (HRQL) for people with schizophrenia. Method:  Randomised controlled trials (RCTs) were considered whether they investigated a yoga intervention in patients with schizophrenia. The selection of studies, data extraction and quality assessment were performed independently by two reviewers. Results:  Only three RCTs met the inclusion criteria. Lower Positive and Negative Syndrome Scale (PANSS) total scores and subscale scores for positive and negative symptoms were obtained after yoga compared with exercise or waiting list control conditions. In the same way, the physical, psychological, social and environmental HRQL as measured with the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) increased more significantly after yoga than after exercise or waiting list control conditions. None of the RCTS encountered adverse events. Dose-response relationships could, however, not be determined. Conclusion:  Although the number of RCTs included in this review was limited, results indicated that yoga therapy can be an useful add-on treatment to reduce general psychopathology and positive and negative symptoms. In the same way, HRQL improved in those antipsychotic-stabilised patients with schizophrenia following yoga.
Abstract: Although schizophrenia is the fifth leading cause of disability-adjusted life years worldwide in people aged 15 to 44 years, the clinical evidence of physical therapy as a complementary treatment remains largely unknown.
Abstract: Vancampfort D, Probst M, Scheewe T, Knapen J, De Herdt A, De Hert M. The functional exercise capacity is correlated with global functioning in patients with schizophrenia. Objective:  The 6-minute walk test (6MWT) is commonly used to measure the functional exercise capacity in chronic patients with cardiovascular diseases. The purpose of this study was to determine whether the 6MWT is associated with the global assessment of functioning (GAF) score in patients with schizophrenia. Methods:  A total of 68 male and 25 female in-patients with schizophrenia (34.6 ± 9.7 years; body mass index = 24.9 ± 4.4) performed a 6MWT and were assessed with the GAF scale and the Psychosis Evaluation tool for Common use by Caregivers (PECC). Results:  The mean distance walked on the 6MWT was 587.3 ± 98.4 m, while the mean GAF score was 52.0 ± 10.4. The Pearson's correlation coefficient between the 6MWT and the GAF score was 0.59 (P < 0.001), indicating a moderate association between both measures. The 6MWT was also significantly related to negative (r = -0.45, P < 0.001), depressive (r = -0.48, P < 0.001) and cognitive (r=, P) symptoms and with body mass index (r = -0.31, P < 0.005), smoking behaviour (r = -0.36, P < 0.001)) and dose of antipsychotic medication (r = -0.38, P < 0.001). Conclusion:  Next to the GAF scale, clinicians in in-patient settings should consider incorporating the 6MWT into their test battery to measure the functional consequences of schizophrenia and its treatment.
Abstract: This study examined the association between sedentary behaviour and metabolic parameters among patients with schizophrenia. A total of 76 patients and 38 healthy age-, gender- and BMI-matched volunteers were included. Participants were asked for their overall sitting and physical activity behaviour using the International Physical Activity Questionnaire. Patients were additionally screened for psychiatric symptoms and extrapyramidal side-effects of antipsychotic medication. On average, patients with schizophrenia spent 8.5h per day sitting (versus 6.21h in healthy controls). Patients sitting more than 10.4h per day had a higher BMI, waist circumference and fasting glucose concentrations and experienced more negative and cognitive symptoms than those sitting less than 5.8h per day. Overall sitting time was associated with a significantly greater likelihood of metabolic syndrome. A stepwise backward-elimination multivariate regression analysis demonstrated that sitting time is a significant predictor for BMI. Current results suggest patients with schizophrenia may benefit from reducing total sitting time.
Abstract: Vancampfort D, Knapen J, Probst M, Scheewe T, Remans S, De Hert M. A systematic review of correlates of physical activity (PA) in patients with schizophrenia. Objective:  The present review evaluates systematically the published quantitative studies of correlates of PA in patients with schizophrenia. Method:  EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL and PEDro were searched from their inception to 1 July 2011 combining the medical subject heading 'schizophrenia' with 'physical activity' or 'physical inactivity' or 'exercise' or 'health education' or 'health behaviour' or 'health promotion'. Results:  Out of 68 potentially eligible studies, 25 papers (n = 25 013) evaluating 36 correlates were included. Correlates consistently associated with lower PA participation are the presence of negative symptoms and cardio-metabolic comorbidity. Also, side-effects of antipsychotic medication, lack of knowledge on cardiovascular disease risk factors, no belief in the health benefits, a lower self-efficacy, other unhealthy lifestyle habits and social isolation correlated with lower PA participation. The quality of the PA measurement was not related to the proportion of significant associations (χ(2)  = 3.8, P = 0.07). Current gaps in literature that need to be examined more in detail are the role of environmental and policy-level factors on PA participation in patients with schizophrenia. Conclusion:  All correlates should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.
Abstract: 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.
Abstract: We examined the reproducibility of the 6-min walk test (6 MWT) in patients with schizophrenia. Secondary aims were to assess minimal detectable changes and practice effects of the 6 MWT and the presence of clinical conditions that might interfere. From 71 patients with schizophrenia two trials of the 6 MWT, administered within 3 days, were analysed. The intraclass correlation coefficient between the two tests was 0.96. The minimal detectable change was 56.2m for men and 50.2m for women. Body mass index, daily antipsychotic dose, negative and depressive symptoms, resting heart rate, age, smoking behavior and different musculoskeletal complaints were all significantly associated with the distance walked. The 6 MWT can be recommended for evaluating the functional exercise capacity in patients with schizophrenia. Some practice effect could however not be excluded.
Abstract: Worsening of schizophrenia symptoms is related to stress and anxiety. People with schizophrenia often experience difficulties in coping with stress and possess a limited repertoire of coping strategies. A randomised comparative trial was undertaken in patients with schizophrenia to evaluate changes in state anxiety, psychological stress and subjective well-being after single sessions of yoga and aerobic exercise compared with a control condition.
Abstract: This study compared differences in functional exercise capacity between patients with schizophrenia and healthy controls. Physical self-perception and physical activity variables contributing to the variability in the distance achieved during a walk test were identified.
Abstract: OBJECTIVE: To investigate the reproducibility of the Eurofit physical fitness test battery in patients with schizophrenia or schizoaffective disorder. Secondary aims were to assess clinical and demographic characteristics that correlate with the performance on the Eurofit and evaluation of the feasibility of the test. METHODS: Fifty patients with schizophrenia or schizoaffective disorder (mean age of 32.9±9.5years) with a mean body mass index (BMI) of 26.1±6.0kg/m(2) performed two Eurofit tests administered within 3days. RESULTS: All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.72 for flamingo balance to 0.98 for standing broad jump test. All participants could perform five of the seven test items without problems. The whole body balance and abdominal muscle endurance test could be executed by 74 and 90%, respectively. Significant correlations were found with age, BMI, waist circumference, dose of antipsychotic medication and extrapyramidal, negative and cognitive symptoms. CONCLUSIONS: The Eurofit test showed good reproducibility and can be recommended for evaluating physical fitness parameters in patients with schizophrenia or schizoaffective disorder. Physical fitness measures were related to both physical and mental health parameters.
Abstract: Objectives. To examine walking capacity in patients with schizophrenia and the relation with quality of life and physical activity level. Methods. Functional exercise capacity was measured with the 6 Minute Walk Test (6MWT). To asses quality of life and physical activity levels, we used respectively the SF-36 Questionnaire and the Baecke Physical Activity Questionnaire. Results. Walking capacity was strongly related to BMI and quality of life. Physical Activity (PA) was positively related to walking capacity. Conclusion. Present findings confirm that walking capacity could be a good indicator of quality of life and PA level in patients with schizophrenia. Key words: Schizophrenia, physical activity, quality of life.
Abstract: Patients with schizophrenia frequently undergo a disturbance of body experience. This can occur during an acute psychotic phase or during a period of remission.
Abstract: The aim of this review was to assess the quality of physical activity recommendations within clinical practice guidelines for the prevention and treatment of the cardio-metabolic risk factors in schizophrenia. Several databases were searched from their inception through July 2010. The Appraisal of Guidelines for Research and Evaluation instrument was used for the quality assessment. Twelve recommendations met all the in- and exclusion criteria. The overall agreement of the quality assessment using the intraclass correlation coefficient was 0.90. Comparison identified considerable variation in the quality of the content. Based on quality assurance standards, only one of 12 guidelines was recommended. Differences on in-depth analysis suggest a lack of consistency in relation to information about the potential role of physical activity in reducing cardiometabolic risks in schizophrenia. High quality recommendations are highly needed along with specific practical advice for persons with schizophrenia, family members and health care professionals.
Abstract: The aim of the present study was to identify if lack of physical activity participation and an impaired functional exercise capacity compared with healthy controls contributed to an impaired health related quality of life (HRQL). We also evaluated whether the presence of metabolic syndrome (MetS) could explain the variability in HRQL in patients.
Abstract: To examine the efficacy of a single progressive muscle relaxation session compared with a control condition on state anxiety, psychological stress, fatigue and subjective well-being in patients with schizophrenia.
Abstract: AIM: The primary aim of this study was to determine whether the presence of the metabolic syndrome (MetS) limits physical activity (PA) in patients with schizophrenia. A secondary aim was to investigate cross-sectional associations of leisure-time PA, sports participation and PA performance with MetS parameters. METHODS: Patients with schizophrenia who had MetS (n=37) were compared with those without MetS (n=69). Patients were assessed for PA performance using a 6-minute walk test (6MWT) and PA participation using the Baecke PA questionnaire, as well as for antipsychotic medication dose (expressed in chlorpromazine equivalents), negative symptoms and smoking behaviour. RESULTS: The two patient groups were similar in age, gender, mean antipsychotic medication dose, negative symptomatology and smoking behaviour. Distance achieved on the 6MWT was 13.7% shorter (P<0.001) in patients with versus patients without MetS (527.6±108.9m vs 610.0±93.7m, respectively). Patients with MetS were also significantly less involved in sports activities (P=0.001) and less physically active during leisure time (P=0.002). Also, the distance of the 6MWT was moderately correlated with body mass index (r=-0.44, P<0.001), waist circumference (r=-0.43, P<0.001), sports participation (r=0.60, P<0.001) and leisure-time PA (r=0.42, P<0.001). CONCLUSION: MetS is associated with poorer PA performance in patients with schizophrenia. The additional burden of MetS places patients with schizophrenia at even greater risk for physical and functional limitations in daily life.
Abstract: This article reviews evidence that researchers and mental health service providers need to take into account four modifiable factors that affect the prevalence of the metabolic syndrome in people with schizophrenia: (a) physical activity as part of a health-related lifestyle, (b) physical fitness, (c) mental health status and (d) antipsychotic medication. The implementation of physical activity in order to prevent and treat cardiometabolic risk factors in people with schizophrenia is discussed. English language articles published until July 2009 were identified by PubMed, CINAHL, PsychINFO, and Cochrane Central Register of Controlled Trials. The search terms schizophrenia and metabolic syndrome, physical activity, health, fitness, and lifestyle were used. Physical activity interventions result in positive effects on metabolic outcomes, physical fitness, health-related behavior and mental health. Considering present knowledge, physical therapists should take into account the emotional (negative symptoms, self-esteem, self-efficacy, and stress) and physiological (cardiometabolic parameters) components of mental illness when offering physical activity interventions. The physical activity stimulus should be adapted to the individual's physical fitness level and the side effects of the antipsychotic medications. More research is needed to assist in the practical development of effective evidence-based preventive and curative strategies in psychiatric services for metabolic syndrome in persons with schizophrenia.
Abstract: Only about 25% of people with schizophrenia follow the public health recommendations for a minimum of 150 minutes per week of moderate physical exercise. In their leisure time people diagnosed with schizophrenia take considerably less exercise than their healthy counterparts.
Abstract: To examine whether drive for thinness, body dissatisfaction, and restrictive/binge eating-purging subtype at admission moderates the weight curves of patients with Anorexia Nervosa (AN) over the course of inpatient treatment.
Abstract: In general, psychiatry is not very popular among healthcare providers, although no information is available concerning the attitudes of physiotherapy students towards mental heath. This study examined the attitudes of physiotherapy students towards psychiatry considering the subject's gender, previous experience with psychiatry and the impact of a specific course.
Abstract: Acute aerobic exercise is associated with a reduction in state anxiety and an improvement in subjective well-being. The objective of the present study was to contrast the effects of aerobic exercise at self-selected intensity versus prescribed intensity on state anxiety and subjective well-being (negative affect, positive well-being and fatigue) in patients with depressive and/or anxiety disorders. In addition, the potential impact of heart rate feedback was assessed.
Abstract: Body image is an important feature in the quality of life of clinical and non-clinical subjects. Therefore, the evaluation of different instruments for measuring body image is necessary. More and more attention is also given to the body image of males. This study addresses the body image of non-clinical males in comparison to females by using well-know questionnaires.
Abstract: Lack of self-esteem may play an important role in the development of eating disorders (ED). This study investigated the differential impact of positive and negative feedback on implicit and explicit self-esteem in women with an ED (N=25) as compared to women without an ED (N=29).
Abstract: The weight percentage of body fat in anorexic adolescents on the basis of four distinct formulas (Siri; Lohman; Westrate and Deurenberg; Heyward and Stolarczyk) is compared.
Abstract: Body image disturbance is an important factor in the development and the treatment of eating disorders. Therefore, evaluations of different instruments for measuring body image disturbances are necessary.
Abstract: Little is known about which therapeutic 'ingredients' in the treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED)) are needed for recovery. Remarkably, most studies on this topic have neglected the patient's view.
Abstract: Using Ecological Momentary Assessment, the within patient associations between drive for thinness, emotional states, momentary urge to be physically active and physical activity were studied in 32 inpatients with an eating disorder. Participants received an electronic device and had to indicate at nine random times a day during 1 week their momentary drive for thinness, positive and negative emotional states and their urge to be physically active and physical activity. Multilevel analyses indicated that patients with higher mean levels for urge to be physically active were characterized by lower body mass index (BMI) and chronically negative affect whereas patients with higher mean levels for physical activity were characterized by lower BMI and higher dispositions for drive for thinness. In addition, within patient relations between drive for thinness and urge to be physically active were moderated by BMI and chronically negative affect whereas within patient relations between drive for thinness and physical activity were moderated by BMI. Finally, also positive emotional states were significantly associated with physical activity within patients. By using a daily process design, characteristics of physical activity were revealed that have not been identified with assessment methods that have a lower time resolution.
Abstract: In the study of psychomotor performance in anorexia nervosa (AN), motor control has not been studied extensively. The present study explores sequence planning in a sample of AN patients.
Abstract: In a previous study young seriously underweight anorexia nervosa (AN) patients in the early phase of treatment were found to react faster in psychomotor tasks. To further understand this finding we studied the impact of weight restoration on the performance of AN patients in drawing and copying tasks. A group of 17 female AN patients, aged 14 to 25, was compared with 17 healthy controls, matched for sex, age and educational level. Patients were tested when severely underweight and after weight restoration. Control subjects were also tested twice. Using computerized recording and analysis of writing and drawing behavior, reaction times and drawing times were derived, while cognitive and motor demands were manipulated. Overall, AN patients showed shorter reaction times in copying tasks and shorter drawing time in the drawing task than normal controls, and this pattern persisted after weight restoration. No significant group (AN vs. controls) by session (test vs. retest) effect emerged. The finding of a consistent pattern of shorter reaction and drawing times in AN patients before and after weight restoration is compatible with a personality characteristic of perfectionism and overachievement in AN patients.
Abstract: Hyperactivity is frequently observed in eating disorders, and several biopsychological mechanisms have been proposed to explain its pathogenetic role. In view of the lack of a reliable method to study hyperactive behavior, we did an experiment with experience sampling methodology (ESM). During 1 week, an anorexia nervosa (AN) patient was asked at nine random times a day to report her momentary tendency to be physically active, her emotions and several other variables including calorie expenditure, drive for thinness, attractiveness, obsessions, compulsions, and attitudes towards hyperactivity. Results indicate that the patient's tendency to be hyperactive was (a) positively related to her weight preoccupation and her negative emotions, and (b) negatively related to her positive emotions and the absence of depression. In this patient, obsessions and compulsions were not related to hyperactivity. The usefulness of ESM for studying the role of hyperactivity in AN is discussed.
Abstract: In a previous study, using computerized analysis of fine motor behaviour, seriously underweight anorexia nervosa patients in the early phase of treatment were found to have shorter reaction times, but not movement times, in experimental drawing and copying tasks. These differences persisted with weight restoration.
Abstract: In contrast to anorexia nervosa there is a lack of research on body composition in bulimia nervosa patients. The aim of the study was to examine the body composition in underweight, normal-weight and overweight bulimia nervosa patients in comparison with healthy sedentary females, to assess the changes in body composition and subcutaneous fat after five months treatment, and to analyze the relation between body composition variables.
Abstract: To explore whether underweight anorexia nervosa patients show psychomotor differences relative to normal controls, 32 female hospitalised patients, aged between 14 and 25 years, were compared with 32 healthy, normal weight controls, matched for sex, age and educational level. Using computerised analysis of writing and drawing behaviour, reaction times and movement times and their different components were analysed, while cognitive and motor demands were manipulated in five drawing and copying tasks. Anorexia nervosa patients were, compared to normal weight controls, significantly faster in a drawing task and showed shorter reaction times in copying tasks. Movement times did not differ significantly between the two groups. In the most complex copying task, a significant group x complexity interaction for reaction time (patients shorter) and reinspection time (patients longer) was found. Patients also made more errors than controls. The finding of a consistent pattern of shorter reaction times in underweight anorexia nervosa patients seems to run contrary to previous findings of disturbed cognitive functioning (i.e. impaired attention) in these patients. The differences seem to be related to cognitive factors more than to motor (executive) components.
Abstract: Weight restoration is a crucial element in the treatment of patients with anorexia nervosa. Therefore, the validity of different methods for measuring body composition is important.
Abstract: Since body dissatisfaction is an essential part of anorexia/bulimia nervosa, we wanted to assess the patients' body experience before and after intensive treatment. Body experience was studied in 290 eating disorder patients, admitted to a specialised unit, after six months and again after one year using the Body Attitude Test (BAT), the Eating Disorder Inventory (EDI), and the Eating Disorder Evaluation Scale (EDES). The clearly negative body experience of eating disorder patients evolved in a positive way after therapy and this improvement lasted for up to one year after admission. EDI scores and Body Mass Index at the time of admission appeared to be the strongest predictors of the total BAT score at follow-up. Although body dissatisfaction can be quite persistent in eating disorders, intensive treatment can substantially improve the patients' body experience.
Abstract: Using the video distortion method on a life-size screen, we have studied body size estimation in 100 female restricting anorexia nervosa patients. About half of the patients were accurate in estimating their own body dimensions and only 20% clearly showed overestimation. We then tested whether differences in accuracy of estimation were related to scores on the following questionnaires: Eating Disorder Inventory; Body Attitude Test; and Symptom Checklist (SCL-90). Overestimators reported a more negative body attitude and a more "neurotic profile" on the SCL-90. These differences might have both prognostic and therapeutic implications.
Abstract: The Body Attitude Test (BAT) questionnaire was specifically developed for the assessment of patients with eating disorders. To test its usefulness, the BAT was administered together with other self-report measures (Body Shape Questionnaire, Eating Disorder Inventory, Body Attitude Questionnaire, Rosenberg Self-Esteem Scale) in 69 anorectic, 26 bulimic patients and 165 female university students. The results indicate that the negative body attitude expressed on the BAT is related to other signs of negative body experience. The BAT differentiates between clinical and non-clinical subjects and between anorectics and bulimics.
Abstract: For the first time, body composition has been studied in a very large sample of female anorexia nervosa patients (n 200) using two methods: anthropometry (skinfold thickness) and densitometry (underwater weighing). The concurrent validity of both methods appeared to be good (r 0.84). Although the mean percentage of body fat (13.5) in our sample corresponds with most of the previous reports, the range (4.3-24.8) is great. Our study shows that BMI is not a good measure of fatness. Age and duration of illness were not related to body fat. Percentage fat was found to be different (t 2.76, P < 0.01) according to the diagnostic subtype of anorexia nervosa: restricters (12.9) v. bingers and/or purgers (14.7).
Abstract: The video distortion method on a life-size screen is a new method for studying eating disordered patients' estimations of their own body width. Testing this method in female patients (53 with anorexia nervosa, 38 with bulimia nervosa) and 36 normal females, yielded high to very high reliability scores (consistency and test-retest stability). A careful analysis of the 'just noticeable difference' showed that a 5% deviation from the undistorted image should be considered as within the range of accuracy. Taking this into account, anorectic patients appear to score below, above, as well as within the normal range. Bulimia nervosa patients are either accurate in their body estimations or overestimate their body width. All control Ss are correct in their estimations. With this method no significant differences were found between the anorectic patients and the controls. Bulimics differ significantly from anorectics and controls on their optative responses (i.e. what they wanted to look like) and their affective responses (i.e. what they felt they looked like).
Abstract: To investigate the reliability of the video distortion method in obese children and compare their body image with the body perception of non-obese peers.
Abstract: In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a self-report questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes.
Abstract: It is well known that anorexia nervosa is characterized by a disturbed body image. The video distortion method is one of the many methods to systematically study the perceptual aspect of this body image. Using a distorted image of her own appearance, the subject is asked to reconstruct the 'exact' measures of her body and to indicate her ideal image. The reliability of this method has been assessed in a study involving 67 anorexic patients and 105 female university students. Test--retest results within the same session and over a one-week interval were sufficiently constant. Nonetheless, for both anorexics and controls, significant differences were found between estimates with a narrowed (thin) image initially and those with a widened (fat) image initially. Both groups underestimate their body measures and only significantly differ on estimates of their ideal image, with anorexics clearly less underestimating their ideal image than students.
Abstract: In the patient unit of the University Clinic for Psychiatry at Kortenberg (K.U. Leuven) Belgium and in the Psychosomatic Hospital Bad Pyrmont, which specialises in the treatment of anorexia nervosa, a great deal of attention is given to the evaluation of body image via the video-distortion technique, the video-confrontation technique and the body attitude test (a questionnaire). These different methods as well as the first findings and experiences are described.
Abstract: The body image of the patient suffering from anorexia nervosa is not only an important diagnostic criterion, but also an important aspect of therapy. In the patient unit of the university clinic for psychiatry at Kortenberg (K.U. Leuven), which specialises in the treatment of anorexia nervosa, a great deal of attention is given to body-image through the video confrontation technique. Video recordings are made of each patient on her arrival and departure. The recordings are shown to the patient and her group and discussed afterwards. It is expected that such confrontations will improve the attitude of the patient towards her own body. In order to evaluate these possible changes, the therapist fills out questionnaires at the start and the end of the program. The results of this method are analysed in this article.
Abstract: Though the disturbed body image is an essential phenomenon of anorexia nervosa, hardly any specific attempts are described to alter the way these patients experience their bodies. The authors present a body-oriented treatment method aimed at curbing hyperactivity, rebuilding a realistic self-concept, learning to enjoy one's own body, and developing social skills. The therapy is a mixture of different techniques among which video-confrontation appears to be an important element.
