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Physiotherapists can help implement physical activity programmes in clinical practice

Published online by Cambridge University Press:  02 January 2018

Brendon Stubbs
Affiliation:
School of Health and Social Care, University of Greenwich, Eltham, London, UK
Michel Probst
Affiliation:
KU Leuven Department of Rehabilitation Sciences, Leuven, and University Psychiatric Centre KU Leuven, Kortenberg, Belgium
Andy Soundy
Affiliation:
Department of Physiotherapy, School of Health and Population Science, University of Birmingham, Birmingham, UK
Anne Parker
Affiliation:
Royal Edinburgh Hospital, Morningside, Edinburgh, UK
Amber De Herdt
Affiliation:
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
Marc De Hert
Affiliation:
University Psychiatric Centre KU Leuven, Kortenberg, Belgium
Alex J. Mitchell
Affiliation:
Leicestershire Partnership Trust, Leicester, UK, and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
Davy Vancampfort
Affiliation:
KU Leuven Department of Rehabilitation Sciences, Leuven, and University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. Email: [email protected]; on behalf of the International Organization of Physical Therapists in Mental Health
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2014 

We read with great interest the editorial by McNamee et al. Reference McNamee, Mead, MacGillivray and Lawrie1 The authors made an important call for evidence-based physical activity research and interventions to reduce the physical health disparity seen in people with schizophrenia. Since this an area which is constantly evolving, we wanted to highlight some new evidence that is available that may assist clinicians and researchers to develop evidence-based physical activity interventions.

McNamee et al Reference McNamee, Mead, MacGillivray and Lawrie1 report some important barriers to physical activity uptake and maintenance. However, our understanding of the barriers to physical activity participation go beyond negative symptoms, side-effects of medication and social isolation. Reference McNamee, Mead, MacGillivray and Lawrie1 Recent review evidence Reference Vancampfort, Knapen, Probst, Scheewe, Remans and De2 incorporating 25 013 people with schizophrenia provides further indications of specific barriers which should be considered in this population. This comprehensive review Reference Vancampfort, Knapen, Probst, Scheewe, Remans and De2 suggests that cardiometabolic comorbidity, lack of knowledge on cardiovascular disease risk factors, lower self-efficacy and other unhealthy lifestyle habits, including smoking, must be carefully considered as barriers when developing physical activity interventions for patients with schizophrenia.

We agree with McNamee et al Reference McNamee, Mead, MacGillivray and Lawrie1 that there is a high need for theoretically based research on the motivational processes linked to the commencement and continuation of physical activity in patients with schizophrenia. Research has recently started to meet this call. New evidence relying on the self-determination theory Reference Vancampfort, De Hert, Vansteenkiste, De, Scheewe and Soundy3 suggests that people with schizophrenia’s level of autonomous motivation towards an active lifestyle (which involves the experience of volition and choice), feelings of competence and social relatedness may play an important role in the adoption and maintenance of physical activity.

We also agree with McNamee et al Reference McNamee, Mead, MacGillivray and Lawrie1 that it is essential that all members of the mental health multidisciplinary team (MDT) should promote and empower people with schizophrenia to engage in physical activity. The International Organization of Physical Therapists in Mental Health (IOPTMH) Reference Vancampfort, De Hert, Skjaerven, Gyllensten, Parker and Mulders4 recently emphasised that the mental health MDT’s approach to the care of patients with schizophrenia should take this into account, at both policy-making and clinical levels. Without this crucial step the physical health of patients with schizophrenia is unlikely to be improved. The IOPTMH therefore endorses the editorial of McNamee et al Reference McNamee, Mead, MacGillivray and Lawrie1 that active physical health promotion must be routinely included in the care plans of people with schizophrenia and accepted as the responsibility of all healthcare staff. The IOPTMH is committed to supporting future research in this field and believes that physiotherapists are well placed to lead the translation of physical activity in clinical practice, Reference Stubbs, Soundy, Probst, De, De and Vancampfort5 which McNamee et al Reference McNamee, Mead, MacGillivray and Lawrie1 called for. Future research is required and this should, for example, define which strategies mental health physiotherapists should adopt in order to assist persons with schizophrenia in the transition from hospital to community care. Reference Vancampfort, De Hert, Skjaerven, Gyllensten, Parker and Mulders4,Reference Stubbs, Soundy, Probst, De, De and Vancampfort5 Together with McNamee et al, Reference McNamee, Mead, MacGillivray and Lawrie1 we are convinced that this is essential in order to ensure that physical activity is successfully used to significantly improve the physical health and health-related quality of life of people with schizophrenia.

References

1 McNamee, L, Mead, G, MacGillivray, S, Lawrie, SM. Schizophrenia, poor physical health and physical activity: evidence-based interventions are required to reduce major health inequalities. Br J Psychiatry 2013; 203: 239–41.CrossRefGoogle ScholarPubMed
2 Vancampfort, D, Knapen, J, Probst, M, Scheewe, T, Remans, S, De, Hert M. A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand 2012; 125: 352–62.Google Scholar
3 Vancampfort, D, De Hert, M, Vansteenkiste, M, De, Herdt A, Scheewe, TW, Soundy, A, et al. The importance of self-determined motivation towards physical activity in patients with schizophrenia. Psychiatr Res 2013; 210: 812–8.Google Scholar
4 Vancampfort, D, De Hert, M, Skjaerven, L, Gyllensten, A, 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: 112.CrossRefGoogle ScholarPubMed
5 Stubbs, B, Soundy, A, Probst, M, De, Hert M, De, Herdt A, Vancampfort, D. Understanding the role of physiotherapists in schizophrenia: an International perspective from members of the International Organisation of Physical Therapists in Mental Health (IOPTMH). J Ment Health 2013; in press.Google Scholar
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