Promotion of cardiorespiratory fitness in schizophrenia: a clinical overview and meta-analysis.
OBJECTIVE
Cardiorespiratory fitness (CRF) is a major modifiable risk factor for cardiovascular disease (CVD). We conducted a clinical overview to highlight the reduced CRF expressed as maximal oxygen uptake (VO2max) (or predicted) or peak oxygen uptake (VO2 peak) in people with schizophrenia compared to the general population. We also aimed to identify correlates of and clinical strategies to improve CRF.


METHODS
We systematically searched major electronic databases from inception until November 2014. A meta-analysis calculating the standardised mean difference (SMD) was employed.


RESULTS
CRF was significantly reduced in people with schizophrenia (n = 154) with a SMD of -0.96 (95% CI -1.29 to -0.64) (N = 5) compared to controls (n = 182). Negative symptoms, increased body mass index and female gender were negatively associated with CRF. Promoting physical activity may improve CRF in people with schizophrenia by up to 4-4.5 ml/kg/min following a 6-8 weeks programme (N = 4, n = 98).


CONCLUSIONS
People with schizophrenia have a large and significantly reduced CRF. Given the overwhelming evidence for physical activity as the cornerstone of preventing and managing CVD in the general population, incorporating such interventions in the treatment of people with schizophrenia is justified and urgently required. We present clear practical strategies of how this can be achieved within clinical settings.
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium.
D
D
Vancampfort
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
S
S
Rosenbaum
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium.
M
M
Probst
Department of Physiotherapy, University of Birmingham, Birmingham, UK.
A
A
Soundy
Department of Psycho-oncology, Leicestershire Partnership Trust, Leicester, UK.|Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK.
A J
AJ
Mitchell
Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium.
M
M
De Hert
School of Health and Social Care, University of Greenwich, London, UK.
B
B
Stubbs
D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control; D015444:Exercise / Q000502:physiology* / Q000523:psychology*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology* / Q000523:psychology*; D012307:Risk Factors; D012559:Schizophrenia / Q000503:physiopathology / Q000628:therapy*
exercise; physical activity; physical fitness; psychosis; schizophrenia