The TOPFIT study : 'The outcome of psychosis and fitness therapy'

Abstract

Schizophrenia is a severe psychiatric illness, characterised by positive (psychotic), negative and cognitive symptoms. Despite treatment patients often have relapses and continued disability. In addition, life expectancy of schizophrenia patients is reduced by 20%, largely due to additional prevalence of physical illnesses. The importance of physical activity and fitness for health improvement is well studied and widely accepted in the general population. Yet rigorous studies on the effect of physical activity, in specific exercise therapy, on mental and physical health in patients with schizophrenia are lacking. Results from magnetic resonance imaging (MRI) studies have consistently demonstrated that structural brain abnormalities play a role in the pathophysiology of schizophrenia. The origin of these brain abnormalities is not fully understood, but lack of physical activity and poor cardiorespiratory fitness may play a role. To date, only one neuroimaging study has examined the effect of exercise in schizophrenia and found hippocampus volume enlargement after training. The studies described in this thesis address the before mentioned gaps in literature. The aim of the TOPFIT study was threefold: 1.to explore differences in physical activity, cardiorespiratory fitness, and energy intake between schizophrenia patients and matched, healthy control subjects; 2.to examine whether exercise therapy can improve mental and physical health of patients with schizophrenia; 3.to investigate whether exercise therapy is able to attenuate progressive brain abnormalities found in schizophrenia patients. The TOPFIT study comprised a multicentre randomised controlled trial, including patients with schizophrenia as well as physically inactive but otherwise healthy controls. In the TOPFIT study, schizophrenia patients were randomised to 2 hours of exercise therapy or occupational therapy weekly for 6-months. Healthy controls were randomised to the same 6-month cardiovascular exercise program versus life-as-usual. First, the TOPFIT study showed that: · Patients with schizophrenia were less physically active and had decreased cardiorespiratory fitness levels compared to physically inactive but otherwise healthy control subjects; · Energy and nutrient intake of schizophrenia patients was similar as compared to matched healthy controls or a BMI-matched sample of the general population. When controlling for BMI, physical activity and fitness, total energy and carbohydrate intake was higher in patients compared to controls; · Physical inactivity and especially cardiorespiratory fitness, not energy intake, were associated with obesity and negative symptomatology in schizophrenia patients. Second: · Exercise therapy, when performed 1-2 hours weekly, reduced psychotic symptoms, depressive symptoms, and need for care; · Six months of biweekly exercise therapy improved cardiorespiratory fitness of patients with schizophrenia and healthy controls, but no significant effects on other physical health parameters were found. Third: · 1-2 hours of exercise therapy weekly for 6 months did not significantly effect brain volume changes in schizophrenia patients or healthy controls; · Cardiorespiratory fitness improvement, irrespective of intervention, was associated with attenuated global brain volume changes in schizophrenia patients and cortical thickening (or less cortical thinning) in large areas of the left hemisphere, in both schizophrenia patients as well as in healthy controls.