Promoting Physical Activity in Schizophrenia Patients

A pilot study in BMC Psychiatry suggests that a technique called “Mental Contrasting and Implementation Intentions (MCII)” is a promising way to promote physical activity in patients with schizophrenia spectrum disorders.

The physical and mental benefits of exercise are well known, but for patients with developed schizophrenia or on the spectrum, encouraging exercise can be particularly challenging. Earlier research has shown that individuals with schizophrenia spend significantly more time sleeping and sedentary than the general population. “…Deficits in cognition, perception, affect, and volition make it especially difficult for people with schizophrenia to plan and follow through with their exercising intentions, as indicated by poor attendance and high drop-out rates in prior studies,” the study authors note. The problem can be exacerbated by antipsychotic drugs, which can introduce weight gain and sleeping difficulties.

MCII is a form of cognitive behavioral therapy that has been shown to be an effective and easily applicable strategy for patients who have difficulty setting and reaching goals. In brief, it helps patients identify a personal goal, imagine the future outcomes of reaching that goal, and mentally contrast that outcome with personal obstacles—with the ultimate goal of finding instrumental means to overcome the obstacle. It has been used previously in chronic back pain patients to increase physical activity.

The study authors note that a patient’s insight into his or her disorder and its treatment is an important prognostic factor for the positive course of schizophrenia. Many treatment approaches allow patients to take responsibility for themselves rather than being highly regulated and therapist-controlled. The researchers posited that the MCII technique would be significantly more effective in autonomy-focused versus highly structured patient populations. Patients were recruited from two types of wards with different degrees of autonomy (quasi-experimental variation) and allocated to two conditions (intervention vs. control; experimental variation).

Thirty-six inpatients (eleven women) with a mean age of 30.89 years (SD = 11.41) diagnosed with schizophrenia spectrum disorders from specialized highly structured or autonomy-focused wards were randomly assigned to two intervention groups. In control group, patients read an informative text about physical activity; they then set and wrote down the goal to attend jogging sessions. In the MCII experimental condition, patients read the same informative text and then worked through the MCII strategy.

When applied in autonomy-focused settings, MCII increased attendance and persistence in jogging group sessions relative to the control condition. In the highly structured setting, no differences between conditions were found, most likely due to a ceiling effect. These results remained even when adjusting for group differences in the pre-intervention scores for the control variables depression, physical activity, weight, age, and education. Whereas commitment and physical activity apart from the jogging sessions remained stable over the course of the treatment, depression and negative symptoms were reduced.

“We also found evidence of a moderating effect related to the type of setting in which patients live: Motivational strategies designed to address the intention-behavior gap work differently in living environments with different degrees of autonomy,” the study authors noted. “This theoretically well-supported observation calls for systematic empirical research…Self-regulation strategies, specifically the combination of strategies targeting goal setting as well as goal striving, might constitute a set of time- and cost-efficient tools that can simultaneously benefit the health of patients and tight public budgets.

It’s important to note that study patients received standard treatment for psychiatric symptoms, and all improved during the project period. MCII had no additional effect on their psychiatric symptoms. “However, given the short treatment period, the main focus of the present study was on attendance and persistence in the jogging program rather than on examining the effect of exercise behavior on psychiatric symptoms,” the study authors noted.