PT Outcomes with Psychiatric Patients

By Veronica Valencia
Objectives
To look at the current, available literature on PT outcomes when working
with patients affected by a psychiatric disorder.

To provide a brief review of the most common psychiatric disorders

mentioned during the literature search: Schizophrenia, bipolar disorder,
depression, and eating disorders.

To discuss the benefits of physical activity on patients affected by a

psychiatric diagnosis.

To discuss the limitations in the available evidence exploring the PT

outcomes on psychiatric populations
Methods
Databases used: PEDro, Proquest (MEDLINE)

Date of Search: July 22 - 24, 2017

Key words: physical therapy, psychiatric, schizophrenia, bipolar, depression,

eating disorder, outcomes

Exclusion criteria:

Articles not available in English

Subject age below 18 y/o

Inclusion criteria:
Results
16 total research articles were identified that met the inclusion and
exclusion criteria.

5 were obtained from Proquest (MEDLINE)

11 were obtained from PEDro

Schizophrenia
Schizophrenia is characterized by impairments that severely impact the
ability to perform activities, and participate in social/occupational roles.

Individuals with Schizophrenia usually experience at least two of the

following:

Hallucinations (visual or auditory are most common)

Disorganized speech

Delusions: false beliefs that are fixed

Extreme motor behaviors

Flat affect: severe reduction in emotional expressiveness

Depressive Disorders
Depressive disorders are marked by sadness that is severe, interferes with
function and leads to decreased interest or pleasure in activities.

There are seven diagnostic disorders, but the most commonly encountered
by PTs are:

Major depressive disorder (MDD)

Major depressive disorder with seasonal pattern (SAD)

Etiology is associated with genetic, biologic, and psychosocial factors.

Neurotransmitters (norepinephrine/dopamine/serotonin) may also play a
role.
Eating Disorders
Eating disorder (ED) is the general term used to describe an obsession with
food and weight in adolescence or adulthood. It can include:

Anorexia nervosa

Bulimia nervosa

Binge Eating Disorder (BED)

Often seen in obese individuals

Although attributed to psychologic and emotional factors, the cause of

eating disorders remains unknown. They are now considered
multifactorial biopsychosocial disorders.
PT Outcomes on Patients with Schizophrenia
There have been calls to incorporate physical activity in psychiatric services
for some time (Richardson et al., 2005), yet little research has
documented the practice of physical therapists in physical activity
prescription in schizophrenia.

In a study by Marzolini et al (2009), that followed 15 in-patient Schizophrenia

patients receiving physical therapy treatment for 12 weeks, participants
had a significant improvement in their short-term memory, a result that
was related to an increase in hippocampal volume. Their PT treatment
consisted of aerobic training, strength training, or both.
PT Outcomes on Patients with Schizophrenia
In a study by Duraiswamy et al (2007) that followed 41 individuals receiving
either inpatient or outpatient physical therapy (aerobic and strength
training) for 16 weeks, participants reported a statistically significant
reduction in positive and negative symptoms of Schizophrenia (24 vs 33%,
and 18 vs 35%, respectively).

However, another study by Behere et al (2011) following 66 individuals

receiving either outpatient physical therapy or yoga for 3 months,
reported significant reductions in positive and negative symptoms after
yoga, but no significant reductions after aerobic and strength training
interventions.
PT Outcomes on Patients with Schizophrenia
Furthermore, reductions in body mass index (BMI) were shown in the
studies of Battaglia et al. (2013) and Takahashi et al. (2012), which
followed 18 and 23 patients receiving outpatient PT during a span of 12
weeks.

Research shows that physical activity is associated with improved quality of

life, psychological well-being and overall mental and physical health in
people with schizophrenia.
PT Outcomes on Patients with Eating Disorders
A study by Sundgot Borgen et al. (2002) following 64 bulimia patients found
that patients who followed a combination of aerobic and strength training
reported less binges per week and less post treatment body
dissatisfaction and drive for thinness as measured with the Eating
Disorder Inventory than patients who followed cognitive behavioural
therapy or nutrition counselling, or those allocated to a wait list

Carei et al. (2010) conducted a study with 50 outpatient anorexia patients,

and demonstrated that following 8 weeks, twice a week, yoga also
resulted in significantly lower Eating Disorder Examination scores for
bulimia patients when compared to those in a wait-list control condition
PT Outcomes on Patients with Eating Disorders
A study by Chantler et al. (2006) also demonstrated that adding low intensity
resistance training to the standard care of patients with anorexia nervosa
resulted in a higher body mass index, muscle strength, and body fat
percentage compared to standard care alone.

The use of aerobic exercises in the treatment for anorexia nervosa,

however, is not without controversy. Many patients with anorexia nervosa
engage in excessive exercise, which can contribute to ongoing weight loss.
PT Outcomes on Patients with Depression
Five separate studies conducted between 1991 and 2006, yielded significant
positive results for exercise intervention in improving depression or
depressive symptoms.

One study conducted by Singh et al. (2009), which followed 60 patients

diagnosed with depression for a period of 8 weeks, showed that
participants who were assigned to a higher intensity of progressive
resistance training showed significantly higher levels of improvement in
depression compared with those in a low-intensity progressive resistance
training condition, or a control group.
PT Outcomes on Patients with Depression
A study by Chiechanowski et al. (2004), which followed 138 patients with
minor depression over a period of 12 months, reported that participants
in the intervention group showed significant improvement in depression
at six months and 12 months follow-up. They were also more likely to
have at least a 50% reduction in depressive symptoms, and to achieve
complete remission from depression at 12 months.

Physical activity interventions in this study were delivered by social workers

Limitations of Literature Review
The small sample sizes of the included studies limit overall conclusions and
highlight the need for further research.

The outcome measures and intervention characteristics (frequency,

intensity, time) of the studies used are heterogeneous.
References
Stubbs, B., Soundy, A., Probst, M., De Hert, M., De Herdt, A., Parker, A., & Vancampfort, D. (2014). The assessment, benefits and delivery of
physical activity in people with schizophrenia: a survey of members of the International Organization of Physical Therapists in Mental Health.
Physiotherapy Research International, 19(4), 248-256

Vancampfort, D., De Hert, M., Skjerven, L. H., Gyllensten, A. L., Parker, A., Mulders, N., ... & Probst, M. (2012). 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. Disability and rehabilitation, 34(1), 1-12

Vancampfort, D., Probst, M., De Hert, M., Soundy, A., Stubbs, B., Stroobants, M., & De Herdt, A. (2014). Neurobiological effects of physical
exercise in schizophrenia: a systematic review. Disability and rehabilitation, 36(21), 1749-1754

Silva, J. G. M., Filoni, E., & Fitz, F. F. (2014). Physical therapy in the treatment of body aesthetics dysfunctions-literature review. Manual Therapy,
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Rastad, C., Martin, C., & senlf, P. (2014). Barriers, benefits, and strategies for physical activity in patients with schizophrenia. Physical therapy,
94(10), 1467-1479

Vera-Garcia, E., Mayoral-Cleries, F., Vancampfort, D., Stubbs, B., & Cuesta-Vargas, A. I. (2015). A systematic review of the benefits of physical
therapy within a multidisciplinary care approach for people with schizophrenia: an update. Psychiatry research, 229(3), 828-839
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Marcos de Souza Moura, A., Khede Lamego, M., Paes, F., Ferreira Rocha, N. B., Simoes-Silva, V., Almeida Rocha, S., ... & Budde, H. (2015).
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Vancampfort, D., Vanderlinden, J., De Hert, M., Admkova, M., Skjaerven, L. H., Cataln-Matamoros, D., ... & Probst, M. (2013). A systematic
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Vancampfort, D., Vanderlinden, J., De Hert, M., Soundy, A., Admkova, M., Skjaerven, L. H., ... & Probst, M. (2014). A systematic review of
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Carneiro, L. S., Fonseca, A. M., Vieira-Coelho, M. A., Mota, M. P., & Vasconcelos-Raposo, J. (2015). Effects of structured exercise and
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Carta, M. G., Hardoy, M. C., Pilu, A., Sorba, M., Floris, A. L., Mannu, F. A., ... & Salvi, M. (2008). Improving physical quality of life with group
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