Adherence to a guided walking program with amelioration of cognitive functions in subjects with schizophrenia even during COVID-19 pandemic

S Mandini, M Morelli, M Belvederi Murri, L Grassi, S Masotti, L Simani, V Zerbini, A Raisi, T Piva, G Grazzi, G Mazzoni, S Mandini, M Morelli, M Belvederi Murri, L Grassi, S Masotti, L Simani, V Zerbini, A Raisi, T Piva, G Grazzi, G Mazzoni

Abstract

Background: Aim of the study was to enrol a group of individuals with schizophrenia in a long-term moderate-intensity physical activity program and to evaluate its effects on their cognitive functions and cardiovascular risk factors. An additional aim of the study was the comparison of the adherence to the physical activity program before and during the COVID-19 pandemic.

Methods: Forty sedentary patients diagnosed with schizophrenia (mean age 46.4 ± 9.6) followed by the Public Mental Health Department of Ferrara were included in the study. 28 of them followed a 1-year walking program consisting of two guided walking sessions/week, while 12 maintained their sedentary lifestyle and followed the usual Cognitive Rehabilitation program. To the participants following the walking program VO2 peak and walking speed were assessed at baseline and at the end of the program. All participants were evaluated on blood pressure and anthropometric variable. Cognitive functions were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP) and with the Frontal Assessment Battery (FAB) questionnaires.

Results: The 20 participants completing the walking program displayed significant improvements in cognitive functions (dppc2 0.35 for SCIP and 0.26 for FAB), with a positive correlation between SCIP score and the number of sessions attended (R = 0.86, p < 0.001), evident in the patients attending to at least 75 of the 100 walking sessions. Walking speed and VO2peak increased significantly and a decrease of body weight, BMI, systolic and diastolic blood pressure was also observed. The adherence to the walking program registered during Covid-19 period did not differ from that observed before the pandemic. The 12 CG (Control Group) patients maintaining the sedentary lifestyle did not display improvements of cognitive functions.

Conclusions: The main finding of this study is the improvement of cognitive functions which is significantly related to the number of walking sessions attended by participants with schizophrenia. The walking program, guided by exercise specialists, proved to be an enjoyable activity for people with mental disorder feasible even during the COVID-19 pandemic. Trial registration Retrospectively registered on ISRCTN as non-randomized trial (n. ISRCTN14763786).

Keywords: Cardiovascular risk factors; Mental disorder; Physical activity; Schizophrenia.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1.
Fig. 1.
Study design, according to TREND statement
Fig. 2.
Fig. 2.
SCIP and FAB score variations in the Guided Walking group (WG) and in the Control Group (CG)
Fig. 3.
Fig. 3.
Relationship between number of walking session attended and the increase in SCIP score after 1-year of guided walking
Fig. 4.
Fig. 4.
Number of walking session organized from baseline (T0), 1-year follow up (T12) and during the Covid-19 pandemic (year 2020)

References

    1. Fatouros-Bergman H, Cervenka S, Flyckt L, Edman G, Farde L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014;158:156–162.
    1. Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75:964–974.
    1. Stubbs B, Williams J, Gaughran F, Craig T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res. 2016;171:103–109.
    1. Wildgust HJ, Beary M. Are there modifiable risk factors which will reduce the excess mortality in schizophrenia? J Psychopharmacol Oxf Engl. 2010;24(4 Suppl):37–50.
    1. Wildgust HJ, Hodgson R, Beary M. The paradox of premature mortality in schizophrenia: new research questions. J Psychopharmacol Oxf Engl. 2010;24(4 Suppl):9–15.
    1. Bushe CJ, Taylor M, Haukka J. Mortality in schizophrenia: a measurable clinical endpoint. J Psychopharmacol Oxf Engl. 2010;24(4 Suppl):17–25.
    1. Lawrence D, Kisely S, Pais J. The epidemiology of excess mortality in people with mental illness. Can J Psychiatry Rev Can Psychiatr. 2010;55:752–760.
    1. Bora E, Akdede BB, Alptekin K. The relationship between cognitive impairment in schizophrenia and metabolic syndrome: a systematic review and meta-analysis. Psychol Med. 2017;47:1030–1040.
    1. Nemani K, Li C, Olfson M, Blessing EM, Razavian N, Chen J, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiat. 2021;78:380–386.
    1. Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull. 2020;46:752–757.
    1. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Globally altered sleep patterns and physical activity levels by confinement in 5056 individuals: ECLB COVID-19 international online survey. Biol Sport. 2020;38:495–506.
    1. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey. Int J Environ Res Public Health. 2021;18:4329.
    1. World health report: 2002. . Accessed 10 Nov 2021.
    1. WHO/Europe|Motion for your mind: physical activity for mental health promotion, protection and care (2019). . Accessed 24 Sep 2021.
    1. World Health Organization, Regional Office for Europe. Physical activity strategy for the WHO European Region 2016–2025. Copenhagen: World Health Organisation Regional Office for Europe; 2016.
    1. Daimiel L, Martínez-González MA, Corella D, Salas-Salvadó J, Schröder H, Vioque J, et al. Physical fitness and physical activity association with cognitive function and quality of life: baseline cross-sectional analysis of the PREDIMED-Plus trial. Sci Rep. 2020;10:3472.
    1. Firth J, Stubbs B, Vancampfort D, Schuch FB, Rosenbaum S, Ward PB, et al. The validity and value of self-reported physical activity and accelerometry in people with schizophrenia: a population-scale study of the UK Biobank. Schizophr Bull. 2018;44:1293–1300.
    1. Vancampfort D, De Hert M, Skjerven LH, Gyllensten AL, Parker A, Mulders N, et al. International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia. Disabil Rehabil. 2012;34:1–12.
    1. Vancampfort D, Knapen J, Probst M, van Winkel R, Deckx S, Maurissen K, et al. Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia. Psychiatry Res. 2010;177:271–279.
    1. Andersen E, Holmen TL, Egeland J, Martinsen EW, Bigseth TT, Bang-Kittilsen G, et al. Physical activity pattern and cardiorespiratory fitness in individuals with schizophrenia compared with a population-based sample. Schizophr Res. 2018;201:98–104.
    1. Vancampfort D, Firth J, Schuch FB, Rosenbaum S, Mugisha J, Hallgren M, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry Off J World Psychiatr Assoc WPA. 2017;16:308–315.
    1. Erickson KI, Weinstein AM, Lopez OL. Physical activity, brain plasticity, and Alzheimer’s disease. Arch Med Res. 2012;43:615–621.
    1. Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2017;43:546–556.
    1. Kimhy D, Lauriola V, Bartels MN, Armstrong HF, Vakhrusheva J, Ballon JS, et al. Aerobic exercise for cognitive deficits in schizophrenia—the impact of frequency, duration, and fidelity with target training intensity. Schizophr Res. 2016;172:213–215.
    1. Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011;168:472–485.
    1. Bryce S, Sloan E, Lee S, Ponsford J, Rossell S. Cognitive remediation in schizophrenia: a methodological appraisal of systematic reviews and meta-analyses. J Psychiatr Res. 2016;75:91–106.
    1. Revell ER, Neill JC, Harte M, Khan Z, Drake RJ. A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophr Res. 2015;168:213–222.
    1. Chang C-H, Lane H-Y, Tseng P-T, Chen S-J, Liu C-Y, Lin C-H. Effect of N-methyl-D-aspartate-receptor-enhancing agents on cognition in patients with schizophrenia: a systematic review and meta-analysis of double-blind randomised controlled trials. J Psychopharmacol Oxf Engl. 2019;33:436–448.
    1. Mandini S, Conconi F, Mori E, Myers J, Grazzi G, Mazzoni G. Walking and hypertension: greater reductions in subjects with higher baseline systolic blood pressure following six months of guided walking. PeerJ. 2018;6:e5471.
    1. Mandini S, Collini G, Grazzi G, Lavezzi E, Mazzoni G, Conconi F. Reduction in risk factors for cardiovascular diseases and long-lasting walking habit in sedentary male and female subjects following 1 year of guided walking. Sport Sci Health. 2018;14:121–126.
    1. Mandini S, Conconi F, Mori E, Caruso L, Grazzi G, Mazzoni G. Guided walking reduces blood pressure in hypertensive sedentary subjects including those with resistant hypertension. J Hum Hypertens. 2021;35:226–231.
    1. Mandini S, Conconi F, Mori E, Grazzi G, Mazzoni G. Guided walking is more effective than suggested walking in reducing the blood pressure of hypertensive sedentary subjects and in modifying their lifestyle. Sport Sci Health. 2020;16:375–381.
    1. Purdon S. (2005) SCIP Manual. 2005.
    1. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology. 2000;55:1621–1626.
    1. ACSMs Health Related Physical Fitness Assessment Manual. 4th edition. . Accessed 24 Sep 2021.
    1. Chiaranda G, Myers J, Mazzoni G, Terranova F, Bernardi E, Grossi G, et al. Peak oxygen uptake prediction from a moderate, perceptually regulated, 1-km treadmill walk in male cardiac patients. J Cardiopulm Rehabil Prev. 2012;32:262–269.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Morris JN, Hardman AE. Walking to health. Sports Med Auckl NZ. 1997;23:306–332.
    1. Lenhard W, Lenhard A. Computation of effect sizes. Psychometrica. 2017 doi: 10.13140/RG.2.2.17823.92329.
    1. Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5:739–746.
    1. Belvederi Murri M, Folesani F, Costa S, Biancosino B, Colla C, Zerbinati L, et al. Screening for cognitive impairment in non-affective psychoses: a comparison between the SCIP and the MoCA. Schizophr Res. 2020;218:188–194.
    1. Belvederi Murri M, Folesani F, Costa S, Morelli AC, Scillitani V, Guaiana G, et al. Italian validation of the screen for cognitive impairment in psychiatry. Commun Ment Health J. 2020;56:1411–1418.
    1. Firth J, Carney R, Elliott R, French P, Parker S, McIntyre R, et al. Exercise as an intervention for first-episode psychosis: a feasibility study. Early Interv Psychiatry. 2018;12:307–315.
    1. Mazzoni G, Chiaranda G, Myers J, Sassone B, Pasanisi G, Mandini S, et al. 500-meter and 1000-meter moderate walks equally assess cardiorespiratory fitness in male outpatients with cardiovascular diseases. J Sports Med Phys Fitness. 2018;58:1312–1317.
    1. Mazzoni G, Myers J, Sassone B, Pasanisi G, Mandini S, Raisi A, et al. A moderate 200-m walk test estimates peak oxygen uptake in elderly outpatients with cardiovascular disease. J Sports Med Phys Fitness. 2020;60:786–793.
    1. Chiaranda G, Bernardi E, Codecà L, Conconi F, Myers J, Terranova F, et al. Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study. BMJ Open. 2013;3:e003446.
    1. Grazzi G, Myers J, Bernardi E, Terranova F, Grossi G, Codecà L, et al. Association between VO2 peak estimated by a 1-km treadmill walk and mortality. A 10-year follow-up study in patients with cardiovascular disease. Int J Cardiol. 2014;173:248–52.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren