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Phd

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Davy Vancampfort

on 9 June 2013

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Transcript of Phd

1. Introduction 2. The importance of physical health 3. The importance of physical activity and health related physical fitness 4. Correlates Symptoms Metabolic Syndrome in Schizophrenia: Relationships with Physical Activity, Functional Exercise Capacity and Eurofit Test Battery Performance Louis Wain delusions hallucinations desorganized negative symptoms Schizophrenia Lifetime prevalence rates 1.) 0.3 to 0.66% of the population 2.) men vs. women 5. conclusion Metabolic syndrome Correll, C.U., et al. (2006). Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. Journal of Clinical Psychiatry, 67, 575-583. In patients treated with second generation antipsychotic drugs, the metabolic syndrome is associated with a significantly greater age- and race adjusted 10-year risk of coronary heart disease events, i.e. 11.5% versus 5.3% (risk ratio=2.18; 95%CI=1.88-2.48, p<0.001) for men and 4.5% versus 2.3% (risk ratio=1.94; 95%CI=1.65-2.23, p=0.005) for women. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders: a systematic review and meta-analysis.
Mitchell, A.J., Vancampfort, D., Sweers, K., Yu, W., De Hert, M.
Schizophrenia Bulletin, doi:10.1093/schbul/sbr148. 77 publications
27 countries
n=25,692
The overall rate of metabolic syndrome was 32.5% (95%CI=30.1% to 35.0%). Etiology a 30 years shortened life expectancy Guideline concordant monitoring of metabolic risk in people treated
with antipsychotic medication: systematic review and meta-analysis of screening practices.
Mitchell, A.J., Delaffon, V., Vancampfort, D., Correll, C.U., De Hert, M.
Psychological Medicine 2012;42(1):125-147. screened in 69.8% of the patients screened in 47.9% of the patients The importance of physical health D. Vancampfort Promoters: Prof. Dr. M. Probst & Prof. Dr. M. De Hert A systematic evaluation and comparison of the guidelines for screening and monitoring of cardiometabolic risk in people with schizophrenia.
De Hert, M., Vancampfort, D., Correll, C.U., Mercken, V., Peuskens, J., Sweers, K., van Winkel, R., Mitchell, A.J.
British Journal of Psychiatry 2011;199:99-105. 18 clinical practice guidelines: USA (n=2), Australia (n=2), Brasil (n=1), Canada (n=1), Europe (n=12) scope and purpose
rigour of development
stakeholder involvement
clarity and presentation
applicability
editorial independence Only 4/18 guidelines can be recommended Quality assessment of physical activity within clinical guidelines for the prevention and treatment of cardiometabolic risk in people with schizophrenia.
Vancampfort, D., Sweers, K., Probst, M., Knapen, J., Mitchell, A.J., De Hert, M.
Community Mental Health Journal 2011;47(6):703-710 Also clinical practice guidelines on physical activity are of limited quality inconsistent
not evidence-based
too vague The importance of physical activity and health related physical fitness Cardiometabolic effects of physical activity interventions for people with schizophrenia.
Vancampfort, D., Knapen, J., De Hert, M., van Winkel, R., Deckx, S., Maurissen, K., Peuskens, J., Simons, J., Probst, M.
Physical Therapy Reviews 2009;14(6):388-398. We identified all articles since 2003 up to August 2009 from Medline, SPORTDiscus, Cochrane Central Register of Controlled Trials, EMBASE, PEDro, DARE, ProQuest Dissertations & Theses and PsycINFO.
13 studies met the inclusion criteria.
No dose-response defined: lack of methodological rigorous studies (limited sample size, no randomized controlled trials) and lack of consistency in interventions.
Compliance to physical activity is crucial. Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia.
Vancampfort, D., Knapen, J., Probst, M., van Winkel, R., Deckx, S., Maurissen, K., Peuskens, J.,
De Hert, M.
Psychiatry Research 2010;177(3):271-279. Perfomed in an indoor corridor with a minimum of external stimuli.
Two cones, 25m apart, indicated the length of the walkway.
Participants were instructed to walk back and forth during six minutes, without running or jogging.
The protocol stated that the testing was to be interrupted if threatening symptoms appeared.
Standardised encouragements were provided at recommended intervals. the 6-minute walk test Eurofit test-items What about validity? Reliability, minimal detectable changes, practice effects and correlates of the six-minute walk test in patients with schizophrenia.
Vancampfort, D., Probst, M., Maurissen, K., Sweers, K., Knapen, J., De Hert, M.
Psychiatry Research 2011;187:62-67. Eurofit test battery in patients with schizophrenia and schizoaffective disorder: reliability and clinical correlates.
Vancampfort, D., Probst, M., Sweers, K., Maurissen, K., Knapen, J., Willems, J.B., Heip, T., De Hert, M.
European Psychiatry, doi:10.1016/j.eurpsy.2011.01.009. hand grip force standing broad jump sit-and-reach plate tapping Patients with schizophrenia (n=80) versus healthy controls (n=40) Relationship between obesity, functional exercise capacity, physical activity participation and physical self-perception in people with schizophrenia.
Vancampfort, D., Probst, M., Sweers, K., Maurissen, K., Knapen, J., De Hert, M.
Acta Psychiatrica Scandinavica 2011;123(6):423-430. Relationships between reduced physical fitness, decreased physical activity participation, smoking and metabolic and mental health parameters in people with schizophrenia.
Vancampfort, D., Probst, M., Scheewe, T., Sweers, K., Maurissen, K., Knapen, J., van Winkel, R., De Hert, M.
Resubmitted. Associations between variables in patients with schizophrenia Associations between sedentary behaviour and metabolic syndrome in patients with schizophrenia.
Vancampfort, D., Probst, M., Knapen, J., Carraro, A., De Hert, M.
Resubmitted. Physical activity participation, functional exercise capacity and self-esteem in patients with schizophrenia with high and low physical self-perception.
Vancampfort, D., De Hert, M., Maurissen, K., Sweers, K., Knapen, J., Raepsaet, J., Probst, M.
International Journal of Therapy and Rehabilitation 2011;18(4):222-228. The association of metabolic syndrome with physical activity performance in patients with schizophrenia.
Vancampfort, D., Sweers, K., Probst, M., Maurissen, K., Knapen, J., Minguet, P., De Hert, M.
Diabetes & Metabolism 2011;37:318-323. Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia.
Vancampfort, D., Probst, M., Scheewe, T., Maurissen, K., Sweers, K., Knapen, J., De Hert, M.
Schizophrenia Research 2011;139(2-3):122-127. 1.) Patients with schizophrenia report more or less half of the total amount of minutes being physically active during the past seven days of the healthy control group.

2.) They expend more or less half of the energy expended by healthy controls.

3.) Patients with schizophrenia sit more than 8 hours per day compared to 6 hours in the healthy control group.

4.) Only 15% of schizophrenia patients have a (high) physically-active lifestyle compared to 35% in the healthy control group (as measured with the International Physical Activity Questionnaire). Physical (in)activity levels 1.) Except for hand grip force, patients with schizophrenia performed worse on all the Eurofit test items: decreased flexibity, speed of limbs, explosive strength, abdominal muscular endurance, whole body balance.

2.) In patients with schizophrenia, the distance achieved on the walk test was in general 19.3% lower (137.1m, p<0.001) compared to healthy subjects (573.5m versus 760.6m).

2.) Before and after the walk test, schizophrenia patients reported more physical problems and discomforts. Physical fitness
1.) The Cartesian mind-body dichotomy is both outdated and dangerous. The price of good mental health must not be a lifetime of physical illness.

2.) Public stigma is a widespread and well-documented major access barrier for patients with schizophrenia. Stigma may cause people with schizophrenia to delay or to avoid seeking treatment. It is responsible for the low priority given to funding for scientific research and to the implementation of integrated health services. The demonstration that the simultaneous attention to treatment of mental and physical illness improves the long-term outcomes of both might help to change this situation.

3.) Physical therapists should support the personal empowerment in patients with schizophrenia, enabling them to make healthy choices for recovery. Physical activity might help these patients to become more effective managers of their chronic illness, improving a range of self-management and health outcome measures. Appositions What is unique to patients with schizophrenia is their great difficulty in breaking the pattern of an unhealthful lifestyle and preventing its consequences due to factors related to their illness and its treatment.

Till the time our approach to the care of patients with schizophrenia takes this into account, both at policy-making and clinical levels, the outcome of patients with schizophrenia is unlikely to change. Our data offer preliminary evidence that increasing physical activity participation should be a key target in the multidisciplinary treatment of patients with schizophrenia, especially in unfit patients with an increased cardiometabolic risk profile, in patients with a low physical self-perception and in patients with more negative and cognitive symptoms. Metabolic Syndrome in Schizophrenia: Relationships with Physical Activity, Functional Exercise Capacity and Eurofit Test Battery Performance
Prof. Dr. L. Vanhees
Department of Rehabilitation Sciences, KU Leuven, Belgium Chair of the Examining Committee: Jury Members: Prof. Dr. C.U. Correll
The Zucker Hillside Hospital, Glen Oaks, New York, USA and the Albert Einstein College of Medicine, Bronx, New York, USA

Prof. Dr. B. De Cuyper
Department of Human Kinesiology, KU Leuven, Belgium

Prof. Dr. R. Gosselink
Department of Rehabilitation Sciences, KU Leuven, Belgium

Prof. Dr. P. Hespel
Department of Biomedical Kinesiology, KU Leuven, Belgium the socio-ecological model of physical activity in patients with schizophrenia A systematic review of correlates of physical activity in patients with schizophrenia.
Vancampfort, D., Knapen, J. Probst, M., Scheewe, T., Remans, S., De Hert, M.
Acta Psychiatrica Scandinavica: doi: 10.1111/j.1600-0447.2011.01814.x.
Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven
U.P.C. KULeuven, campus Kortenberg We identified 48 studies (n=290,534) in five countries. The 6MWT and Eurofit test are reliable instruments. Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Mitchell, A.J., Vancampfort, D., De Herdt, A., Yu, W., De Hert, M. Submitted. We compared the metabolic syndrome risk factors of 24,892 medicated patients with chronic schizophrenia with those of 2,548 patients in their first episode of schizophrenia with 1,325 unmedicated patients with schizophrenia. High need for:
1.) Longitudinal studies
2.) Interventional studies
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