Exercise therapy for schizophrenia

 

Abstract

Background

The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia.

Objectives

To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses.

Search methods

We searched the Cochrane Schizophrenia Group Trials Register (December 2008) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We also inspected references within relevant papers.

Selection criteria

We included all randomised controlled trials comparing any intervention where physical activity or exercise was considered to be the main or active ingredient with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses.

Data collection and analysis

We independently inspected citations and abstracts, ordered papers, quality assessed and data extracted. For binary outcomes we calculated a fixed-effect risk ratio (RR) and its 95% confidence interval (CI). Where possible, the weighted number needed to treat/harm statistic (NNT/H) and its 95% confidence interval (CI), was also calculated. For continuous outcomes, endpoint data were preferred to change data. We synthesised non-skewed data from valid scales using a weighted mean difference (WMD).

Main results

Three randomised controlled trials met the inclusion criteria. Trials assessed the effects of exercise on physical and mental health. Overall numbers leaving the trials were similar. Two trials compared exercise to standard care and both found exercise to significantly improve negative symptoms of mental state (Mental Health Inventory Depression:1RCT, n=10, MD 17.50 CI 6.70 to 28.30, PANSS negative: 1RCT, n=10, MD -8.50 CI -11.11 to -5.89). No absolute effects were found for positive symptoms of mental state. Physical health improved significantly in the exercise group compared to those in standard care (1RCT, n=13, MD 79.50 CI 33.82 to 125.18), but no effect on peoples' weight/BMI was apparent. One trial compared exercise with yoga and found that yoga had a better outcome for mental state (PANSS total: 1RCT, n=41, MD 14.95 CI 2.60 to 27.30). The same trial also found those in the yoga group had significantly better quality of life scores (WHOQOL Physical: 1RCT, n=41, MD -9.22 CI -18.86 to 0.42). Adverse effects (AIMS total scores) were, however, similar.

Authors' conclusions

Results of this Cochrane review are similar to existing reviews that have examined the health benefits of exercise in this population. Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia. Larger randomised studies are required before any definitive conclusions can be drawn.

 

Plain language summary

Exercise Therapy for Schizophrenia

Regular exercise and physical activity is thought to improve both physical and mental health. Although only three studies are included in this review, the overall results show that regular exercise can help some individuals with schizophrenia improve their physical and mental health and well-being. Future studies should address how best to help individuals with schizophrenia begin, and continue to exercise.

 

摘要

背景

以運動療法治療精神分裂症

根據證實生理活動和運動對健康是有好處的，可能對患有精神分裂症的病人能有所幫助。

目標

於患有精神分裂症或精神分裂相關疾病的病人實施運動/生理活動的療程後評估其對心理健康的影響。

搜尋策略

我們搜尋了Cochrane Schizophrenia Group Trials Register (2008年12月) ，也定期搜尋CINAHLE、MBASE、MEDLINE和PsycINFO等資料庫，同時也檢閱所選擇文章的相關參考文獻。

選擇標準

我們納入不管是用標準的治療方式或是其他的治療模式的所有精神分裂症或精神分裂症相關疾病的病人去比較在介入生理活動和運動後是否能成為主要或有效療法的隨機對照試驗。

資料收集與分析

我們獨立地檢閱引文和摘要、排序文獻、評估其品質和數據的擷取。對於二元資料的結果，我們利用fixedeffect risk ratio (RR) 和其95% confidence interval (CI) 來計算。在允許的條件下，會加權number needed to treat/harm statistic (NNT/H) 和其95% confidence interval (CI) 來計算。對於連續變項的結果，如有端點數據則寧願更改數據。我們利用weighted mean difference (WMD) 的有效尺度而得到非偏態的數據。

主要結論

共有3個隨機對照試驗符合納入的標準。試驗主要評估運動對生理和心理健康的影響。且離開此試驗的總人數是相似的。有兩項試驗 (Beebe 2005和Marzaloni 2008) 是去比較運動對標準治療的影響，其結果都可發現運動可以顯著改善心理狀態的負面症狀 (心理健康憂鬱量表：1RCT, n = 10, MD 17.50 CI 6.70 to 28.30, PANNS negative:1RCT, n = 10, MD −8.50 CI −11.11 to −5.89) 。對於心理狀態的正面症狀沒有明顯地影響。與標準治療組 (1RCT, n = 13, MD 79.50 CI 33.82 to 125.18) 相比較，發現運動組在生理健康上有明顯地改善，但在體重/BMI上沒有明顯地影響。Duraiswamy 2007則是比較運動項目中有瑜珈，其發現瑜珈對心理狀態的改善有較好的結果 (PANNS total: 1RCT, n = 41, MD 14.95 CI 2.60 to 27.30) 。同一試驗中也發現瑜伽組其生活品質的評分上有顯著性地較好 (WHOQOL　Physical: 1RCT, n = 41, MD −9.22 CI −18.86 to 0.42) 。然而在各組副作用 (AIMS總分) 結果是相似的。

作者結論

這篇Cochrane review和現已存在的review結果相似，都已證實運動對精神分裂症的病人來說有健康的好處 (Faulkner 2005) 。這篇review雖然納入的研究較少但其包含各種對生理和心理健康的測量結果。結果指出，以規律運動的治療方法對於精神分裂症的病患是可行的，且他們同時可以擁有生理和心理都健康的效果。在有明確的結論之前還需要較大型的隨機對照試驗來證實。

翻譯人

本摘要由吳曉玲翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

以運動療法治療精神分裂症： 規律的運動和身體活動被認為是可改善生理和心理健康。這篇review雖只有納入3項研究，但整體結果顯示，精神分裂症的病患藉由規律運動是可改善其生理和心理的健康。幫助精神分裂症的病患如何學習開始並持續的運動應是未來的研究方向。