Relationships between Physical Activity, Symptoms and Quality of Life among Inpatients with Severe Mental Illness
People with severe and long-standing mental illness often have an inactive lifestyle (Brown et al 1999) and their likelihood of being overweight far exceeds that of the general population (Aronne 2001). They also smoke more and have poorer dietary habits, with a higher intake of fats and sugar, than the general population (Brown et al 1999). The use of antipsychotic medication, which is a core treatment for many patients with severe mental illness, has also been shown to cause weight gain (Fontaine et al 2001).
The elements of inactivity, a poor diet and antipsychotic medication all increase the risk of being overweight or obese and, along with excessive smoking, they also increase the risk of poor physical fitness. Secondary health problems, such as hypertension, type II diabetes and cardiovascular disease, occur more frequently among patients with schizophrenia than in the general population (Sokal et al 2004). Physical activity can help to address the health problems related to being overweight, and may increase patients' willingness to take their medication. Mainly for these reasons, physical activity has become a common element in the treatment and care of hospitalised patients with severe mental illness (Richardson et al 2005). In addition, it has been suggested that participation in valued, everyday life occupations, and the experience of being physically active, may be important contributors to wellbeing and quality of life. This perspective is particularly interesting for occupational therapy suggesting that the psychosocial aspects may be as important to the experience of quality of life as the increased fitness levels achieved by regular physical activity (Cole 2010).
There is growing interest in the study of the relationships between physical activity and mental health in people with mental illness. In reviews and studies of treatments for depression, physical activity has been found to have a substantial positive effect on depressive symptoms (Tkachuk and Martin 1999). A recent review also concluded that physical activity is beneficial in combating mild to moderate depression, as well as in reducing the symptoms of certain forms of anxiety (Martinsen 2008). However, research on the relationship between physical activity and quality of life among patients with mental illness is limited. Physical activity may be one way of alleviating psychiatric symptoms, such as depression and anxiety, but a direct relationship between participation in physical activity and quality of life also seems viable and aligned with an occupational therapy perspective (Cole 2010).
Several studies have found that anxiety (Huppert and Smith 2005) and depression symptoms (Conley et al 2006) are frequent in patients with schizophrenia, and that these symptoms detract from their wellbeing and quality of life (Huppert and Smith 2005, Conley et al 2006). The level of physical activity in this group is generally considered low, as discussed above, but the relationship between physical activity and quality of life has not been addressed in any of these studies.
Research on the effects of physical activity interventions in patients with schizophrenia is in the early stages. Many studies have small sample sizes, and have employed research designs that are far from optimal (Faulkner and Biddle 1999). Studies have suggested a possible effect of physical activity in the direction of less anxiety (Gimino and Levin 2008), less depression (Pelham et al 1993) and increased self-esteem (Plante 1993), as well as improved general health, empowerment and quality of life (Skrinar et al 2005, Duraiswamy et al 2007) among patients with schizophrenia. A recent systematic review based on three randomised controlled trials cautiously concluded that physical activity may increase both mental and physical health among those with schizophrenia, but also stated that the evidence is based on only a few studies with few participants in each study (Gorczynski and Faulkner 2011). …