Schizophrenia and Physical Activity;

From Theory to Practice

Kathi Cameron, BKin. MA (candidate)

School of Physical Education
University of Victoria
Introduction
• Physical inactivity may be related to an increased risk of
heart disease and stroke, colon and breast cancer, obesity,
type 2 diabetes, and mental stresses such as depression and
anxiety (Colman & Walker, 2004).
• In addition, it has been suggested that exercise may reduce
depression and anxiety, enhance cognitive functioning,
social interest, energy, and self-esteem.
• People with schizophrenia are at greater risk for obesity
that may be compounded by the side effects of
antipsychotic drugs (Green, Patel, Goisman, Allison, Blackburn, 2000).
• It has been suggested that moderate exercise should be
prescribed to combat excessive weight gain (Green, et al.,2000).
• There is limited research available that examines the
impact of exercise on those individuals with mental illness
(Fogarty & Happel, 2005).
 What does the literature suggest?
• Research suggests that 40-80% of people with
schizophrenia taking antipsychotic medication gain
weight exceeding the ideal body weight by 20% or
greater (Umbricht, Pollack & Kane, 1994; Masand, Blackburn, Ganguli, Goldman & Gorman,
1999).

• Faulkner and Biddle (1999) reviewed 11 studies focused on

exercise as an adjunct treatment for schizophrenia and
found that the existing research suggests exercise is useful
for the reduction of some of the negative symptoms of
schizophrenia, depression and anxiety.

• Exercise was shown to reduce auditory hallucinations and

improve sleep patterns, self-esteem and general behavior in
people living with schizophrenia (Faulkner & Sparks, 1999).
 What has been done?
• Six residents in a Community Care Unit in Melbourne,
Australia participated in a three month structured exercise
program and reported positive benefits in physical, mental,
and social health (Fogarty & Happell, 2005).
• One study reported a significant reduction in depression
levels and an increase in aerobic fitness for five patients
with long term diagnosis of schizophrenia through the
participation in an exercise program (Pelham, Campagna, Ritvo, & Bernie, 1993).
• Belcher (1988) found a 92% reduction in the occurrence of
hallucinations among people with schizophrenia who
participated in regular exercise.

• Participation in an exercise program has also been linked to

the increase in self-image, reduced anxiety levels and
agression (Sheehan, 1991; Sule, 1987).
 Theories to Consider
• Health Belief Model (Hochbaum, Kegels & Rosenstock, 1951)

• Behavior will occur if the individual believes the health risks are
real, that preventative measures will be effective, perceives the
behavior as possible and does not see many barriers.

• Transtheoretical Model (Prochaska & DiClemente, 1986)

• Defines five stages an individual may go through when adopting a

new behavior

• Theory of Planned Behavior (Ajzen, 1985)

• Suggest there are three variables that may lead to the intent and ultimately
the behavior itself.
 Related Research…
• Courneya, Plotnikoff, Hotz, & Birkett (2001)
• Over 50 studies looking at SOC and exercise behavior
• PBC predicted inactive to active stages
• There has been no longitudinal studies

• Sheeran, Conner, & Norman (2001)

• PBC and Intention highest predictor of behavior
• Less experienced with behavior = less intention to perform

• Armitage, Sheeran, Conner, & Arden (2004)

• TPB variables provide discrimination between stages (I.e.
maintenance stage = positive attitude
• Behavior Intention may predict preparation and maintenance
stage
• Enhancing PBC may assist the individual through the stages
 Determinants of Physical Activity
• Individual, social, and environmental factors play a
significant role in the decision to be physically active.

• Considerations such as socioeconomic status, education

levels, communities, and discrimination factors may all
have an influence on the overall health and activity level of
the individual (McElroy, 2002).

• Frankish, Milligan, and Reid (1998) support this by stating

the importance of acknowledging the individual’s physical
activity history, education level, beliefs and attitudes, and
the influence of social networks on the success of physical
activity adherence.
Considerations for Exercise Adherence
• Research suggests this population is no different than that
of others in the adherence rates of exercise (60% drop out
before six months).

• Group activity is best for enhanced social cohesion and

exercise enjoyment.

• Those that do not choose their activities may not reap the
mental health benefits and may drop out sooner than those
that enjoy the activity they are participating in.

• Physical activity vs. exercise/fitness (enjoyment vs.

measurement and evaluation)
 So what?
• When designing an exercise program for individuals living
with schizophrenia consider the following barriers to
participation:
• Personal beliefs and attitudes regarding exercise
• Influences of fitness culture
• Group cohesion
• Personal choice
• Exercise enjoyment
• Convenience
• Leader’s beliefs and attitudes regarding exercise
 From Theory to Practice
• Partnership:
• EMP Psychiatric Day Hospital & University of
Victoria

• Location:
• University of Victoria Fitness/Weight Center

• Program Design:
• 2 sessions / week; 1.5 hours / session

• Duration:
• 8 weeks

• Participation:
 Program Design
• Screening of referrals through PAR-Q

• Progressive resistance exercise over 8 weeks

• “Star System” and journaling employed

• Support:
• Personal trainer and volunteer supervision
• Therapist support
• Transportation support
• User fee support
Follow Up
• Maintenance program transferred to Oak
Bay Municipal Recreation Center
• Supporting one personal trainer
• One session per week
• Therapist intervention twice per week:
• Social structure support
• Responsible for journals
• Responsible for admission
• Referrals continue to join
 What did the participants have to say?
• Background: 2nd ST Program
• 3 men / 7 women between the ages of 21-55
• 80% retention
• Client Feedback
• “I noticed my depression would lift and I could workout some of
my frustration and anger. My medication has been reduced since I
started exercising.”

• “It got me back into doing things I used to do. My illness made me
withdraw. This allowed me to get my confidence back. To use the
abilities I had lost.”

• “Even if I get a reprieve from my depression of 20 minutes after

exercising, it’s worth it.”

• “I was less obsessed with the side effects of my meds and my

illness and focused my frustration on the weights.”
Considerations for Program
Leaders…
• Exercise environment
• Acknowledge individual differences
• Make a personal connection with each
participant
• Inclusion and cohesion
• Avoid judgment
• Make the shift from physiology to
psychology!
Thank you for your time
and attention!

Kathi Cameron,
250.472.4038
kcameron@uvic.ca