Paul Gorczynski

Exercise Therapy for Schizophrenia

For people with mental health disorders such as schizophrenia, improvement in quality of life tends to enhance the individual’s ability to cope with and manage their disorder. As such, physical activity has the potential to improve quality of life for people with mental health disorders through two routes: physical and psychological (Faulkner 2006). In terms of physical health, individuals with mental health disorders have the same physical health needs as the general population. Individuals with serious mental illness are more likely to be sedentary than the general population (Brown 1999; Chamove 1986; Davidson 2001) and are consequently at high risk for chronic medical conditions associated with inactivity. For example, much of the increase in chronic medical illness among individuals with serious mental illness may be attributed to the increased prevalence of obesity in this population (Goff 2005) and physical inactivity likely contributes to this increased prevalence. In terms of mental health, positive psychological effects from physical activity in clinical populations have been reported even among those individuals who experience no objective diagnostic improvement. Improved quality of life is particularly important for individuals with severe and enduring mental health problems when complete remission may be unrealistic (Faulkner 1999). For example, there is a potential role for exercise in the treatment of schizophrenia, Faulkner 2005 concludes that exercise may alleviate secondary symptoms of schizophrenia such as depression, low self-esteem and social withdrawal.

Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis

Exercise can improve clinical outcomes in people with severe mental illness (SMI). However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions. Understanding the motivating factors and barriers towards exercise for people with SMI would help to maximize exercise participation. A search of major electronic databases was conducted from inception until May 2016. Quantitative studies providing proportional data on the motivating factors and/or barriers towards exercise among patients with SMI were eligible. Random-effects meta-analyses were undertaken to calculate proportional data and 95% confidence intervals (CI) for motivating factors and barriers toward exercise. From 1468 studies, 12 independent studies of 6431 psychiatric patients were eligible for inclusion. Meta-analyses showed that 91% of people with SMI endorsed ‘improving health’ as a reason for exercise (N = 6, n = 790, 95% CI 80–94). Among specific aspects of health and well-being, the most common motivations were ‘losing weight’ (83% of patients), ‘improving mood’ (81%) and ‘reducing stress’ (78%). However, low mood and stress were also identified as the most prevalent barriers towards exercise (61% of patients), followed by ‘lack of support’ (50%). Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise. Providing patients with professional support to identify and achieve their exercise goals may enable them to overcome psychological barriers, and maintain motivation towards regular physical activity.

Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: a focus group study.

OBJECTIVE To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. DESIGN Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. PARTICIPANTS Sixteen community-dwelling adults with SCI (62.5% tetraplegia, 37.5% paraplegia; at least one-year postinjury) whose PA levels ranged from sedentary to regularly active. RESULTS Content analyses revealed that the preferred media for obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. CONCLUSIONS The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times.

Exploring the Construct Validity of the Transtheoretical Model to Structure Physical Activity Interventions for Individuals with Serious Mental Illness

OBJECTIVE Physical activity intervention research involving individuals with serious mental illness are often not based on any theoretical framework. This study examined the construct validity of the Transtheoretical Model (TTM) in individuals with serious mental illness to guide future physical activity interventions. METHODS Fifty-four individuals completed surveys that asked about their current stage of change for physical activity, self-efficacy, and perceived advantages and disadvantages of being more physically active. RESULTS Most individuals reported being in the preparation stage of the TTM. As individuals approached the action and maintenance stages, self-efficacy and perceived benefits of physical activity increased significantly. Although perceived disadvantages decreased with each successive stage, this change was not significant. CONCLUSIONS This studys findings support the TTMs application in this population to structure physical activity interventions given that self-efficacy, perceived benefits of and barriers to physical activity differed across stages and changes were in the direction predicted by theory.

Physical activity and individuals with spinal cord injury: accuracy and quality of information on the Internet

BACKGROUND A number of websites on the Internet promote health-enhancing behaviors among people with spinal cord injury (SCI). However, the information available is of unknown accuracy and quality. OBJECTIVE To examine the accuracy, quality, and targeting strategies used in online physical activity (PA) information aimed at people with SCI. METHODS A purposive sample of 30 frequently accessed websites for individuals with SCI that included PA information was examined. Websites were evaluated based on their descriptive characteristics, level of accuracy in relation to newly defined PA recommendations for people with SCI, technical and theoretical quality (i.e., use of behavioral theories) characteristics, and targeting strategies to promote PA among people with SCI. Descriptive statistics were utilized to illustrate the results of the evaluation. RESULTS PA information was easily accessible, as rated by the number of clicks required to access information. Only 6 websites (20%) provided specific PA recommendations and these websites exhibited low accuracy. Technically, websites were of high quality with a mean score of 4.1 of a possible 6 points. In contrast, websites had a low level of theoretical quality, with 23 of the 30 websites (77%) scoring below 9 of a possible 14 points (i.e., 64% of a perfect score) for theoretical content. A majority of websites evaluated did not use cognitive (e.g., self-efficacy, self-talk, and perceived social norms) and behavioral (e.g., self-monitoring, motivational readiness, and realistic goal-setting) strategies in their messages. A majority (80%) of the evaluated websites customized information for persons with different injury levels and completeness. Less than half of the websites evaluated tailored PA information toward people at different stages of their injury rehabilitation (37%) or for their caregivers (30%). CONCLUSION Accuracy and theoretical quality of PA information presented to people with SCI on the Internet may not be optimal. Websites should be improved to incorporate accepted PA recommendations and behavioral theory to better deliver health messages about PA.

Psychiatric illness and obesity: recognizing the "obesogenic" nature of an inpatient psychiatric setting.

OBJECTIVE The prevalence of obesity and obesity-related diseases is higher among individuals with psychiatric illness than in the general population. This study examined environmental factors that contribute to obesity in one psychiatric hospital in Canada. METHODS Semistructured interviews were conducted with 25 key stakeholders from multiple professional disciplines at the hospital. Transcribed interviews were analyzed through content analysis with the analysis grid for environments linked to obesity (ANGELO) framework as a categorical template. RESULTS Factors contributing to obesity in this setting were related to increased energy intake, such as easy access to high-calorie snacks and beverages, and reduced energy expenditure, such as lack of access to staircases. CONCLUSIONS Psychiatric settings may contribute to the high prevalence of obesity among individuals with psychiatric illness. Ecologically framed interventions are required to address obesity in this population.

A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia

Abstract Purpose: To review and synthesise the literature detailing the use of social support to facilitate physical activity participation in individuals with schizophrenia. Method: A systematic review of major electronic databases was conducted to identify literature regarding the use of social support to promote physical activity among people with schizophrenia. A narrative synthesis was undertaken in four stages, including development of a theory, developing a preliminary synthesis, exploring relationships and assessing the robustness of the synthesis. Results: From a total of 110 studies, 23 met the inclusion criteria including 883 individuals with schizophrenia. Informational support was the most documented form of social support, followed by emotional, esteem and tangible. Providers included research personnel, healthcare professionals, family members and peers. Details of the content of the different dimensions of functional support are given. Social support appears to have an important role to help individuals with schizophrenia initiate, comply and adhere with exercise interventions. Social support may have an indirect benefit on weight maintenance. However, due to the limitations of the selected literature, it was difficult ascertain what the (in)direct benefit of social support are on health outcomes. Conclusions: Social support appears to play a pivotal role in initiating physical activity as well as ensuring compliance and adherence to physical activity. Future research is required to investigate the optimal type and mode of delivery of social support on health outcomes. Implications for Rehabilitation Limited evidence is available that considers the role, value and use of social support within physical activity interventions for individuals with schizophrenia. Social support appears most likely to aid an individual’s initiation, adherence and compliance to physical activity interventions. There may be an indirect benefit of social support on maintaining or enhancing health outcomes.

Mental health service provision in low and middle income countries

This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics–how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.

Adherence to Diabetes Medication in Individuals with Schizophrenia: A Systematic Review of Rates and Determinants of Adherence.

INTRODUCTION Despite the importance of medication adherence for the effective treatment of type II diabetes mellitus (T2DM), little research has examined adherence with diabetes medication treatment in schizophrenia. The purpose of this systematic review was to: 1) evaluate rates of adherence and determinants of adherence with medication for T2DM in individuals with schizophrenia; and, where possible, 2) examine the relationship between medication adherence and glycemic control. METHODS Studies were included if they presented information on dosing regimens and adherence or compliance rates for T2DM and included samples where at least 50% of the participants were individuals with schizophrenia. RESULTS Six studies were included in this review that predominantly examined men over the age of 50 years. Studies confirmed that many individuals with schizophrenia were not adhering to their diabetes medication as adherence rates ranged from 51-85%. Two studies that compared medication adherence in individuals with and without schizophrenia found those with the mental illness had higher rates of adherence. One study reported that blood glucose control levels were not statistically different between those who did and did not adhere to their medication, indicating more research is necessary in this area. Factors that improved adherence included disease and medical service and medication-related factors. CONCLUSIONS Interventions to increase diabetes medication adherence in schizophrenia need to address disease and medical service and medication-related factors. Further research needs to examine diabetes medication adherence in women, younger individuals, and those recently diagnosed with diabetes as these individuals have been underrepresented in the literature.

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

Abstract Purpose: It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH. Methods: PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: “HIV” OR “AIDS” AND “physical activity” OR “exercise” OR “sports”. A random effects meta-analysis was conducted. Results: Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37–58 years). PLWH spent 98.9 (95%CI = 64.8–133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI = 39.3–62%) (n = 2052) of PLWH complied with the physical activity guidelines of 150 min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI = 5678–6418), which is below the 10,000 steps per day recommendation. Conclusions: Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted. Implications for Rehabilitation Many people living with HIV do not comply with general health recommendations. Physical activity counseling should be key in the rehabilitation of people living with HIV.