Abstract
BackgroundExercise may improve cardiorespiratory fitness in people with schizophrenia, however, possible condition-specific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group. The primary aim of this study, therefore, was to investigate the effect of high-intensity interval training on VO2max in people with schizophrenia. Second, we sought to determine whether the intervention would have an effect on general physical activity (PA) level and body composition.MethodsEighty-two patients with schizophrenia were randomly assigned to supervised high-intensity interval training or computer gaming skills training, performed twice a week for 12 weeks. Oxygen uptake was measured directly, during a maximum exercise session on a treadmill. PA level were assessed using ActiGraph accelerometer, and body composition was assessed by bioelectrical impedance. Differences between groups were assessed by analysis of variance using a univariate general linear model.ResultsThere were no significant differences between the groups on any of the cardiorespiratory variables neither at baseline nor after the program. There were also no significant within-group differences in any of the cardiorespiratory fitness variables between the baseline and post-program time points, despite that 61% of the participants performing high-intensity interval training showed a significant increase in workload on the treadmill. However, 47% of the participants in the high-intensity interval training group had a ≥ 5% increase in VO2max. Participants supervised by mental health care providers with PA competence (e.g. rehabilitation center staff, sport scientist, physical trainer) had a much larger increase in VO2max compared to participants supervised by mental health workers without such competence, and when adding PA competence to the model, the intervention group increased VO2max significantly compared to the comparison group. The intervention had no significant effect on PA level or body composition.ConclusionsThe intervention did not improve VO2max, PA level or body composition but succeeded in increasing workload on the treadmill. With regard to VO2max, approximately half of the patients may be considered responders.Trial registrationClinicalTrials.gov; NCT02205684, registered July 2014,
Highlights
Exercise may improve cardiorespiratory fitness in people with schizophrenia, possible conditionspecific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group
Defined daily doses of antipsychotics was slightly higher in the intervention group compared to the comparison group
Half of our participants were supervised by physical activity (PA) professionals and when adding PA competence to the model there was a significant increase in cardiorespiratory fitness (CRF) in the intervention group compared to the comparison group
Summary
Exercise may improve cardiorespiratory fitness in people with schizophrenia, possible conditionspecific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group. It is likely due to a complex interplay among many factors, such as the metabolic side effects of antipsychotics (i.e., leading to overweight) [7], tobacco smoking [8], alcohol misuse [9], poor dietary habits [10], low help-seeking behavior [11] and a possible genetic susceptibility to cardiovascular disease in people with schizophrenia [12, 13]. Low levels of moderate and vigorous intensity physical activity (MVPA) [14,15,16], excessive amounts of sedentary time [16, 17] (defined as any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents while in a seated or reclining posture [18]), and poor cardiorespiratory fitness (CRF) levels [15, 19], have been recognized as potentially important factors for the high prevalence of somatic disorders [20,21,22]. It is proposed that a high prevalence of chronotropic incompetence (attenuated heart rate response to exercise) [26, 29], reduced activity of the efferent vagal system [30] and mitochondrial dysfunction [31, 32] may be condition-specific factors related to their CRF level
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