Therapeutic effects of maximal strength training on walking efficiency in patients with schizophrenia – a pilot study

Abstract

BackgroundPatients with schizophrenia frequently have disabling gait deficits. The net mechanical efficiency of walking (ϵnet) is an accurate measure often used to evaluate walking performance. Patients with gait deficits have a reduced ϵnet with excessive energy expenditure during sub-maximal walking. Maximal strength training (MST) improves ϵnet in healthy individuals and is associated with reduced risk of mortality. The aim of this study was to investigate whether MST improves ϵnet in patients with schizophrenia.MethodsPatients (ICD-10 schizophrenia, schizotypal or delusional disorders (F20-F29)) were included in a non-randomized trial. Patients were assigned to one of two groups: 1) MST consisting of 4x4 repetitions at 85-90% one repetition maximum (1RM) performed in a leg press apparatus or 2) playing computer games (CG). Both groups carried out their activity three days per week for eight weeks. 1RM, ϵnet at 60 watt walking, peak oxygen uptake (VO2peak), the Positive and Negative Syndrome Scale (PANSS) and the 36-items short form (SF-36) were measured pre and post intervention.ResultsThe baseline ϵnet was 17.3 ± 1.2% and 19.4 ± 3.0% in the MST (n = 6) and CG groups (n = 7), respectively, which is categorized as mechanical inefficiency. The MST group improved 1RM by 79 kg (p = 0.006) and ϵnet by 3.4% (p = 0.046) more than the CG group. The MST group improved 1RM and ϵnet, by a mean of 83 kg (p = 0.028) and 3.4% (p = 0.028), respectively. VO2peak at baseline was 34.2 ± 10.2 and 38.3 ± 9.8 ml·kg-1·min-1 in the MST and CG groups, respectively, and did not change (p > 0.05). No change was observed in PANSS or SF-36 (p > 0.05).ConclusionsMST improves 1RM and ϵnet in patients with schizophrenia. MST could be used as a therapeutic intervention for patients with schizophrenia to normalize their reduced ϵnet.

Strength training-induced responses in older adults: attenuation of descending neural drive with age

“…While the importance of neural factors in strength training in the elderly population should yet be treated with some caution because of the low sample size and limited muscle groups studied in the current study, recommendations of heavy resistance training with emphasis on maximal mobilization in the concentric phase has provided excellent results not only in this study, but in a wide range of untrained patient populations (de Vos et al 2005;Hoff et al 2007;Caserotti et al 2008;Husby et al 2009;Fimland et al 2010;Fimland et al 2011;Heggelund et al 2012;Hill et al 2012;Mosti et al 2013). Although the isometric training may also account for some of the adaptations, these studies together present mounting evidence that heavy resistance training not only is feasible and effective; additionally, no incidents of injury have been reported.…”

A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial

“…Muscle strength maintenance is the basis for preserving functionality and independence in activities of daily living. 10,36 A cohort study of 8,762 men aged 20 to 80 years showed that maximum force is independently and inversely associated with all-cause mortality. 37 A resistance or concurrent training program might improve muscle strength and function.…”

“…The results suggested that patients with schizophrenia can safely participate in and benefit from resistance training; furthermore, the program did improve the mechanical efficiency of walking. 10 Serum BDNF and IGF-1 levels were measured as possible biomarkers of the neurobiological mechanisms of improvement or maintenance of schizophrenia symptoms thorough the exercise intervention. These trophic factors are the most commonly used biomarkers for this purpose, and play a critical role in signaling between various tissues, especially in the central nervous system.…”

“…2,3 A recent systematic review demonstrated that patients with schizophrenia who participate less in physical activities have experience more negative symptoms, antipsychotic side effects, low selfefficacy, and other unhealthy lifestyle habits. 4 The important mental and physical benefits of exercise in patients with schizophrenia include improvement of symptoms, 5,6 a decreased need for care, 7 improved quality of life, 8 increased cardiorespiratory capacity, 9 increased muscle strength, 10 and increased functional capacity. 5 Studies of physical exercise among patients with schizophrenia have examined aerobic exercise, 6,9,11 which is characterized by repeated rhythmic movements of the large muscle groups of the body, such as those in the arms and legs.…”

Effects of Exercise on Physical and Mental Health, and Cognitive and Brain Functions in Schizophrenia: Clinical and Experimental Evidence

“…Thus, Jorn Heggelund et al [40] found that patients with schizophrenia may participate of a secure program of maximum strength training, resulting in an improvement in physical health. In this study of 16 patients, 9 were assigned to the experimental group and 7 for the control group.…”