The benefits of walking for individuals with schizophrenia spectrum disorders: A systematic review

Abstract

Aim: Walking is a popular type of physical activity in individuals with schizophrenia – yet the benefits remain unclear. The aim of this review was to investigate if walking can a) reduce weight and b) have a positive influence on other health parameters in individuals (aged 16 years and over) with schizophrenia spectrum disorders in in- or outpatient settings. Methods: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyse (PRISMA) statement was conducted. Major electronic databases were searched from inception to January 2014. Articles were eligible that: considered the effect of a walking intervention; had included at least 75% of the intervention programme as walking rather than another type of physical activity; considered patients formally diagnosed using standard criteria of schizophrenia or schizo-affective spectrum disorders; and used outcome measures that captured the patient's bio-psychosocial health. Two independent authors conducted the searches, extracted data and completed methodological quality and risk of bias assessment. Results: A total of 10 trials from three countries were included (n=339). Selection, detection and performance biases were identified consistently within the research. There is some evidence to suggest walking interventions may benefit an individual's weight, specifically resulting in small reduction in body mass index or body fat in the short term. Evidence for other health outcomes was limited but no adverse events were reported and walking appears to be safe. The data did not provide enough information for a meta-analysis to be conducted. Conclusion: Walking is a popular and safe form of physical activity among individuals with schizophrenia spectrum disorders. No harmful effects were reported and small, short-term weight reduction was identified. However, the results may not be clinically meaningful and should be viewed with caution due to the medium-to-high risk of bias. The broader benefits of walking are yet to be established. Despite the methodological limitations in the literature, walking should be encouraged in clinical practice but clinicians may need to adopt motivational strategies to increase adherence.

What are the top 10 physical activity research questions in schizophrenia?

“…In the same way, future research is needed to investigate whether brain health in people with schizophrenia is activity-dependent [24]. Recent systematic reviews of qualitative research considering the lived experience of patients have demonstrated that engaging in physical activity can improve confidence, reduce feelings of isolation and have a number of other important positive influences on bio-psychosocial outcomes [31,32]. Moreover, future research should explore the effects of physical activity interventions on other clinically relevant outcomes including inflammatory markers [10], pain [33], osteoporosis [34] and the risk for falls and fractures [35].…”

“…The current evidence is conflicting, for example, while Vancampfort et al [13] found an association between greater time spent sitting and a higher body mass index, Janney et al [72] did not find such association. In the general population, there is undeniable, rigorous evidence that sedentary behavior is, independent of physical activity associated with cardiovascular disease mortality [75].…”

Physical activity ameliorates the association between sedentary behavior and cardiometabolic risk among inpatients with schizophrenia: A comparison versus controls using accelerometry

“…Our data suggest that increasing daily steps might be an important strategy to mitigate metabolic risk in people with established psychosis. Moreover, walking is known to be a favored strategy for physical activity among people with schizophrenia and confers good health benefits [33,34]. Therefore, the combined message of 'sitting less and walking more' might offer health benefits for people with psychosis [35].…”

The Effectiveness of Pilates Training on Physical Parameters in Patients with Schizophrenia

“…The physical health of individuals with schizophrenia is greatly much worse than that of the general population [6,8] and mortality rates remain persistently high, around twice that of the general population [1].…”

“…Patients with schizophrenia are unlikely to decrease weight in response to exercise interventions [8]. For patients with depression, one trial found no weight reducing effect of exercise participation; however, a reduction of waist circumference was found in the intervention group [14].…”