Rui Corredeira

An impaired health related muscular fitness contributes to a reduced walking capacity in patients with schizophrenia: a cross-sectional study

BackgroundPatients with schizophrenia report muscle weakness. The relation of this muscle weakness with performing daily life activities such as walking is however not yet studied. The aim of this study was to quantify walking capacity and health related muscular fitness in patients with schizophrenia compared with age-, gender and body mass index (BMI)-matched healthy controls. Secondly, we identified variables that could explain the variability in walking capacity and in health related muscular fitness in patients with schizophrenia.MethodsA total of 100 patients with schizophrenia and 40 healthy volunteers were initially screened. Eighty patients with schizophrenia (36.8±10.0 years) and the 40 age-, gender- and body mass index (BMI)-matched healthy volunteers (37.1±10.3 years) were finally included. All participants performed a standing broad jump test (SBJ) and a six-minute walk test (6MWT) and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms.ResultsPatients with schizophrenia did have lower 6MWT (17.9%, p<0.001) [effect size (ES)=−1.01] and SBJ (14.1%, p<0.001) (ES=−0.57) scores. Patients were also less physically active (1291.0±1201.8 metabolic equivalent-minutes/week versus 2463.1±1365.3, p<0.001) (ES=−0.91) than controls. Schizophrenia patients with metabolic syndrome (MetS) (35%) had a 23.9% lower (p<0.001) SBJ-score and 22.4% (p<0.001) lower 6MWT-score than those without MetS. In multiple regression analysis, 71.8% of the variance in 6MWT was explained by muscular fitness, BMI, presence of MetS and physical activity participation, while 53.9% of the variance in SBJ-score was explained by age, illness duration, BMI and physical activity participation.ConclusionsThe walking capacity and health-related muscular fitness are impaired in patients with schizophrenia and both should be a major focus in daily clinical practice and future research.

Reliability and validity of 6MWT for outpatients with schizophrenia: A preliminary study.

Although the 6-minute walk test (6MWT) has been widely used in patients with schizophrenia, there is a lack of scientific evidence about its reliability and validity in this population. The first goal of this study was to explore the test-retest reliability of the 6MWT and to identify the associated parameters that contribute to the variability of the distance walked during the 6MWT in outpatients with schizophrenia. The second goal was to assess the criterion validity of the 6MWT in men with schizophrenia. Fifty one outpatients with schizophrenia participated in the study. To test-retest reliability (men=39; women=12), participants performed the 6MWT twice within 3 days interval. To test criterion validity (men=13), peak oxygen uptake (VO2peak) was measured on a treadmill. For the associated parameters with the distance walked (n=51), medications use, smoking behavior, body and bone composition, and physical activity levels were analyzed. No significant differences between the means of the two 6MWTs were found. The intraclass correlation coefficient was 0.94 indicating good reliability. 6MWT correlated significantly with VO2peak (r=0.67) indicating criterion validity. Height, body fat mass, smoking behavior and minutes of PA/week were significantly associated with the 6MWT. Results suggest that 6MWT shows good reliability for individuals with schizophrenia and good validity for the small sample of male participants in this study.

Quality of life and physical activity levels in outpatients with schizophrenia

Objectives: To assess quality of life (QoL) and physical activity (PA) levels of outpatients with schizophrenia and healthy controls matched for age, gender, body mass index (BMI), hip circumference, waist circumference, and waist-to-hip ratio. Additionally, the present study investigated associations between PA levels, QoL, and anthropometric and behavioral measures among outpatients with schizophrenia. Methods: Thirty-two outpatients with schizophrenia and 32 individuals without mental illness were included in the study. QoL and PA levels were assessed by the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-Bref) and by GT3X triaxial accelerometers, respectively. Results: Outpatients with schizophrenia had poorer QoL and lower vigorous PA levels compared with healthy controls (p < 0.05). The group with schizophrenia showed a significant association between higher weight and lower scores in the mental health domain of the WHOQOL-Bref. A higher BMI was also significantly associated with lower scores in the physical health domain of the WHOQOL-Bref. Schizophrenic patients with smoking behaviors were associated with fewer steps per day and with less moderate to vigorous PA. Conclusions: This study seeks to shed some light upon the lifestyle of patients with schizophrenia. New psychosocial approaches should focus on PA, weight, and smoking management, thereby helping these patients to improve their QoL.

Como avaliar a percepção de competência e aceitação social de crianças com paralisia cerebral?Estudo inicial para a determinação das propriedades psicométricas da versão portuguesa da Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral Palsy

The main purpose of this study was to examine the psychometric properties of the Portuguese version of the Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral Palsy. The sample was made up of 108 children (60 boys and 48 girls) with cerebral palsy, aged between 4 and 9 years, who suffered hemiplegia, diplegia or quadriplegia and had an IQ of 70 or higher. Most of the children (n=98) attended regular schools (integrated in kindergarten or primary school); indeed, only 10 children attended special schools for children with special needs. A sub-sample of 41 children filled out the scale in two different moments, separated one to two weeks maximum. The results of Pearson correlations between the two administrations (ranging 0.80 to 0.98) and the Cronbachs alpha (ranging 0.69 to 0.93) showed good reliability of the Portuguese version of the Dutch Pictorial Scale. Moreover, the inter-correlations between the four subscales (r=0.60 or higher) as well the mean scores associated by children with different characteristics (age, sex, medical condition) to the different subscales supported the internal validity of the instrument. Therefore, this study provides initial evidence about the psychometric properties of the Portuguese version of the Dutch Pictorial Scale, which is why its use is recommended to assess the perceived competence and social acceptance of Portuguese children with cerebral palsy.

Behavioural Regulation in Exercise Questionnaire in people with schizophrenia: construct validity of the Portuguese versions

Abstract Purpose: People with schizophrenia have low physical activity levels that can be explained by the restriction in motivation. The Behavioural Regulation in Exercise Questionnaire-2 is a 19-item scale commonly used to assess five different motivational subtypes for physical activity. However, there are limited psychometric analyses of this version in the schizophrenia context. Moreover, there is a lack of information related to the psychometric properties of version 3 of this questionnaire, with 24 items and six different motivational subtypes. The aim of this study was to examine the construct validity of both Portuguese versions in people with schizophrenia. Methods: A total of 118 persons with schizophrenia were included (30 women). Cronbach’s alpha was used for internal consistency, Pearson’s correlation for the retained motivation-types, confirmatory factor analysis for the structural validity of version 2 and exploratory factor analysis for the factor structure of version 3. Results and conclusions: Analyses of version 2 provided an adequate fit index for the structure of the five factors. Exploratory analyses suggested retaining 2 factors of version 3. The results of this study suggest that version 3 was an appropriate measure to assess controlled and autonomous motivation for physical activity in people with schizophrenia and support its use in clinical practice and research. Implications for Rehabilitation This study supports the need to identify the reasons why people with schizophrenia practice physical activity. For that purpose, it is important to use valid and cost-effective instruments. The Portuguese version of BREQ-2 confirmed a 5-factor model and showed adequate fit for the application in people with schizophrenia. However, the incremental indices values were lower than expected. The Portuguese version of BREQ-3 showed acceptable psychometric properties to assess controlled and autonomous motivation for physical activity in people with schizophrenia.

Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia

Abstract Aim: Being physically active is a complex behaviour in patients with schizophrenia. Several factors were identified as barriers to achieving active behaviours in this population. Therefore, the purpose of this study was to investigate among a number of barriers what predicts the most on physical activity (PA) in patients with schizophrenia. Methods: A total of 114 patients (28♀) with schizophrenia were included. Body mass index (BMI) was calculated. Autonomous and controlled motivation (Behavioural Regulation in Exercise Questionnaire – 3), self-esteem (Rosenberg Self-esteem scale), quality of life (World Health Organization Quality of Life Scale – Brief version) and functional exercise capacity (6-minute walk test – 6MWT) were evaluated. Multiple Regression Analysis was applied to assess the effect of these variables on Total PA per week (International Physical Activity Questionnaire – short version). Results: Autonomous motivation and domains of quality of life were positively correlated with Total PA per week. Stepwise multiple regression analyses showed that of all the candidate factors to predict PA, autonomous motivation and global domain of quality of life were found as significant predictors. Conclusion: Our findings help to understand the importance of autonomous motivation and quality of life for PA in patients with schizophrenia. Knowledge about these predictors may provide guidance to improve PA behaviour in this population.

Reliability and accuracy of spatial-temporal gait parameters measured by the WalkinSense

The WalkinSense® is a relatively new device designed to monitor walking exercise. The purpose here was to assess its reliability and accuracy when analysing spatial–temporal gait parameters. Forty-two young adults performed 3 × 400 m walking at moderate intensity on a 400-m standard track, using both the WalkinSense and a pedometer. The between-trial reliability was excellent for all variables, with intraclass correlation coefficient values ranging from 0.90 to 0.98. The absolute and percentage differences between the WalkinSense and the track length were (mean ± standard deviation) −36.7 ± 45.0 m (95% confidence interval: −44.6, 28.6) and 9.2 ± 11.3% (95% confidence interval: −11.2, 7.2), respectively. The absolute and percentage differences between the WalkinSense and the pedometer for number of strides were 0.7 ± 10.5 strides (95% confidence interval: −1.2, 2.6) and 0.1 ± 4.0% (95% confidence interval: −0.7, 0.8), respectively. The WalkinSense system showed excellent reliability for assessing spatial–temporal gait parameters. Considering accuracy, users should be aware of the limitations of the device, which in this study ranged between −0.7% and 0.8% and between −11.2% and 7.2%, for number of strides and travelled distance, respectively.

Association of lifestyle-related factors and psychological factors on quality of life in people with schizophrenia

In people with schizophrenia several factors are associated with poor quality of life (QoL), namely, lifestyle-related factors and psychological factors. However, there has been little research on the impact of these factors on QoL. Therefore, the relation between lifestyle-related factors, psychological factors, and QoL in people with schizophrenia was assessed. A cross-sectional study was conducted among 115 patients (25% women, 50% inpatients). QoL was measured by World Health Organisation Quality of Life- Brief Version. Lifestyle-related factors were assessed, namely physical activity (International Physical Activity Questionnaire- Short Form), sleep quality (Pittsburgh Sleep Quality Index) and dietary intake (Mediterranean Diet score). Psychological factors such as self-esteem (Rosenberg Self-Esteem Scale) and autonomous motivation (Behavioural Regulation Questionnaire- version 3) were also measured. Regression analyses were performed to identify significant predictors of QoL. Results showed that self-esteem predicted better global, physical, psychological and environmental QoL. Physical activity predicted better global and physical QoL, while sedentary time predicted poor social and environmental QoL. Identifying predictors of QoL has implication for the effective design and delivery of lifestyles interventions, including physical activity, dietary education and smoking cessation in people with schizophrenia. Adopting healthy lifestyles may lead to improved physical health, psychological well-being and QoL in this population.

Physical Activity and Women’s Mental Health

Women are twice as likely as men to develop certain mental health conditions such as depression, eating disorders, and anxiety disorders. A multimodal care, including psychotherapies as adjuncts to antipsychotic medications, is acknowledged to be crucial in teaching individual strategies and providing patients with tools to deal with these illnesses. In this scenario, physical activity has become increasingly relevant to promote physical and mental health in women with mental illness. However, it appears that women have unique experiences, risks, and needs that must be taken into account for the treatment strategies. For this reason, the provision of rehabilitation for women with mental illness has been challenging for the mental health systems reform. This underlines the importance of understanding the modern scientific and nonscientific literature about the link between physical activity and mental health in women. This chapter will present research on the relationship between physical activity and mental illness, trying to list female particularities and the advantages of exercise for their health.

Creatine or vitamin D supplementation in individuals with a spinal cord injury undergoing resistance training: A double-blinded, randomized pilot trial

Purpose: Determine whether creatine or vitamin D supplementation improves muscle strength in individuals with spinal cord injury undergoing resistance training. Methods: Thirteen male and one female with spinal cord injury, from two Portuguese rehabilitation centers, were randomized to creatine (3g daily), vitamin D (25000 IU each two weeks) or placebo group in a double-blind design. All participants performed progressive resistance training during eight weeks. The outcome measures, obtained at baseline and after intervention, included: Sum of four skinfolds; Corrected arm muscle area; Seated medicine ball throw; Handgrip strength with dynamometer; Manual wheelchair slalom test and one repetition maximum for Chest press, Triceps, Pec deck and Lat pulldown. Vitamin D levels were obtained in all participants before and after intervention. Results: 71.4% of participants had deficit values of vitamin D. The corrected arm muscle area improved significantly (p<0.05) in creatine group relatively to the control group. There was a significant correlation (p<0.05) between the one repetition maximum Pec deck and levels of vitamin D. Conclusions: Supplementation with creatine may improve muscle strength parameters in individuals with spinal cord injury. Vitamin D deficiency is highly prevalent in this population. It is recommended an initial screening of vitamin D levels at the beginning of the physical rehabilitation process.