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Al-Kayed J, Okoli CC. General Factors That Reduce Cardiovascular Risk in People With Schizophrenia: A Systematic Review. J Cardiovasc Nurs 2023:00005082-990000000-00130. [PMID: 37747326 DOI: 10.1097/jcn.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND The life expectancy of individuals with schizophrenia in the United States is 20% shorter than that of the general population owing to cardiovascular disease (CVD). It is crucial to identify the factors that reduce CVD risk in these individuals. OBJECTIVE In this systematic review, we examined the factors associated with CVD in people with schizophrenia. METHODS We searched 3 electronic databases for English articles published before April 2023. Investigators assessed the factors associated with 2 cardiovascular health outcomes among people with schizophrenia: the 10-year coronary heart disease (CHD)/CVD risk and peak oxygen uptake (VO2Peak/max). RESULTS We retrieved 17 studies from the search. Investigators examined factors affecting 10-year CHD/CVD risk in 11 studies and VO2Peak/max in 6 studies among people with schizophrenia. We found that individuals who had low metabolic symptoms (ie, hypertension and hyperglycemia), did not smoke, engaged in continuous CVD risk assessments, had a shorter duration of the diagnosis and hospitalization, and were of normal weight had a lower 10-year CHD/CVD risk. Furthermore, individuals who engaged in specific physical activity had a higher VO2Peak/max. Finally, those taking antipsychotic medications had a higher 10-year CHD/CVD risk and a lower VO2Peak/max. CONCLUSIONS The CVD risk factors observed in the general population are common among people with schizophrenia. When these risk factors are controlled, the 10-year CHD/CVD risk and VO2Peak/max of these individuals may be improved. Given the elevated CVD risk associated with antipsychotic medications, future researchers should examine modifying CVD risk factors to mitigate the additional risks associated with medication use in this population.
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Chen LJ, Stubbs B, Chien IC, Lan TH, Chung MS, Lee HL, Hsu WC, Ku PW. Associations between daily steps and cognitive function among inpatients with schizophrenia. BMC Psychiatry 2022; 22:87. [PMID: 35120468 PMCID: PMC8815184 DOI: 10.1186/s12888-022-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Walking is the fundamental component of taking steps and is the main form of physical activity among individuals with schizophrenia; it also offers a range of health benefits. This study aimed to examine the associations between daily steps and cognitive function and further explored how many steps were related to better cognitive function among inpatients with schizophrenia. METHODS Inpatients with schizophrenia were recruited from long-stay psychiatric wards across two hospitals (n=199 at site 1 and n=195 at site 2). Daily steps were collected with an accelerometer for 7 days. Four cognitive domains (attention, processing speed, reaction time, and motor speed) were tested at site 1, and two cognitive domains (attention and processing speed) were tested at site 2. The associations of daily steps and levels of steps/day with cognitive function were tested using multivariable linear regressions separated by site. Covariates included demographic variables, weight status, metabolic parameters, and clinical state. RESULTS Participants took an average of 7445 (±3442) steps/day. More steps were related to better attention, processing speed, reaction time, and motor speed after multivariable adjustments. Compared with participants taking <5000 steps/day, those taking ≥5000 steps/day showed significantly better processing speed. Participants taking ≥7500 steps/day were associated with better attention, better reaction time, and better motor speed than those taking <5000 steps/day. CONCLUSION Daily steps are associated with better cognitive function among inpatients with schizophrenia. The optimal benefit for cognitive function among this clinical population is achieving 7500 steps/day or more.
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Affiliation(s)
- Li-Jung Chen
- grid.445057.7Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung, 404 Taiwan
| | - Brendon Stubbs
- grid.37640.360000 0000 9439 0839Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ United Kingdom ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - I-Chia Chien
- grid.454740.6Center for the Development of Teaching and Research, Bali Psychiatric Center, Ministry of Health and Welfare, 33, Huafushan Rd, Bali Distric, New Taipei City, 249 Taiwan
| | - Tsuo-Hung Lan
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan ,grid.260539.b0000 0001 2059 7017Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.59784.370000000406229172Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Shun Chung
- grid.454740.6Jianan Psychiatric Center, Ministry of Health and Welfare, 80, Lane 870, Zhongshan Road, Tainan, 717 Taiwan
| | - Hui-Ling Lee
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan
| | - Wan-Chi Hsu
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, 145 Xingda Rd., South Dist, Taichung, 402, Taiwan.
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Chang YJ, Tuz-Zahra F, Godbole S, Avitia Y, Bellettiere J, Rock CL, Jankowska MM, Allison MA, Dunstan DW, Rana B, Natarajan L, Sears DD. Endothelial-derived cardiovascular disease-related microRNAs elevated with prolonged sitting pattern among postmenopausal women. Sci Rep 2021; 11:11766. [PMID: 34083573 PMCID: PMC8175392 DOI: 10.1038/s41598-021-90154-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023] Open
Abstract
Time spent sitting is positively correlated with endothelial dysfunction and cardiovascular disease risk. The underlying molecular mechanisms are unknown. MicroRNAs contained in extracellular vesicles (EVs) reflect cell/tissue status and mediate intercellular communication. We explored the association between sitting patterns and microRNAs isolated from endothelial cell (EC)-derived EVs. Using extant actigraphy based sitting behavior data on a cohort of 518 postmenopausal overweight/obese women, we grouped the woman as Interrupted Sitters (IS; N = 18) or Super Sitters (SS; N = 53) if they were in the shortest or longest sitting pattern quartile, respectively. The cargo microRNA in EC-EVs from the IS and SS women were compared. MicroRNA data were weighted by age, physical functioning, MVPA, device wear days, device wear time, waist circumference, and body mass index. Screening of CVD-related microRNAs demonstrated that miR-199a-5p, let-7d-5p, miR-140-5p, miR-142-3p, miR-133b level were significantly elevated in SS compared to IS groups. Group differences in let-7d-5p, miR-133b, and miR-142-3p were validated in expanded groups. Pathway enrichment analyses show that mucin-type O-glycan biosynthesis and cardiomyocyte adrenergic signaling (P < 0.001) are downstream of the three validated microRNAs. This proof-of-concept study supports the possibility that CVD-related microRNAs in EC-EVs may be molecular transducers of sitting pattern-associated CVD risk in overweight postmenopausal women.
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Affiliation(s)
- Ya-Ju Chang
- Department of Family Medicine, UC San Diego, La Jolla, CA, USA
| | - Fatima Tuz-Zahra
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, CA, USA
| | - Suneeta Godbole
- Department of Family Medicine, UC San Diego, La Jolla, CA, USA
| | - Yesenia Avitia
- Department of Family Medicine, UC San Diego, La Jolla, CA, USA
| | - John Bellettiere
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, CA, USA.,Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA, USA
| | - Cheryl L Rock
- Department of Family Medicine, UC San Diego, La Jolla, CA, USA.,Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | | | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Brinda Rana
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA.,Department of Psychiatry, UC San Diego, La Jolla, CA, USA
| | - Loki Natarajan
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, CA, USA.,Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Dorothy D Sears
- Department of Family Medicine, UC San Diego, La Jolla, CA, USA. .,Moores Cancer Center, UC San Diego, La Jolla, CA, USA. .,Department of Medicine, UC San Diego, La Jolla, CA, USA. .,College of Health Solutions, Arizona State University, 550 N 3rd Street, Phoenix, AZ, 85004, USA.
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Bang-Kittilsen G, Egeland J, Holmen TL, Bigseth TT, Andersen E, Mordal J, Ulleberg P, Engh JA. High-intensity interval training and active video gaming improve neurocognition in schizophrenia: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:339-353. [PMID: 33156372 DOI: 10.1007/s00406-020-01200-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
There is a need for treatments targeting neurocognitive dysfunctions in schizophrenia. The aim of this study was to investigate the neurocognitive effect of aerobic high-intensity interval training (HIIT). A comparison group performed sport simulating active video gaming (AVG). We anticipated that HIIT would improve neurocognition beyond any effect of AVG, due to engagement in higher intensity cardiorespiratory demands. Recent research on the beneficial neurocognitive effect of AVG challenges this expectation but added new relevance to comparing the two interventions. This is an observer-blinded randomized controlled trial. Eighty-two outpatients diagnosed with schizophrenia were allocated to HIIT (n = 43) or AVG (n = 39). Both groups received two supervised sessions per week for 12 weeks. The attrition rate was 31%, and 65% of the participants were defined as protocol compliant study completers. Intention-to-treat analyses showed significant improvements in the neurocognitive composite score from baseline to post-intervention and from baseline to 4 months follow-up in the total sample. The same pattern of results was found in several subdomains. Contrary to our hypothesis, we found no interaction effects of time and group, indicating equal effects in both groups. Separate within-group analysis unexpectedly showed trends of differential effects in the learning domain, as HIIT showed post-intervention improvement in verbal but not visual learning, while AVG showed improvement in visual but not verbal learning. HIIT and AVG improve neurocognition equally, suggesting that both interventions may be applied to target neurocognition in schizophrenia. Future research should investigate trends towards possible differential effects of exercise modes on neurocognitive subdomains. NCT02205684, 31.07.14.
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Affiliation(s)
- Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway.
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Therese Torgersen Bigseth
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of Southeast Norway, Horten, Norway
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Pål Ulleberg
- Department of Psychology, University of Oslo, Oslo, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
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Holmen TL, Egeland J, Andersen E, Mordal J, Andreassen OA, Ueland T, Bigseth TT, Bang-Kittilsen G, Engh JA. The Association Between Cardiorespiratory Fitness and Cognition Appears Neither Related to Current Physical Activity Nor Mediated by Brain-Derived Neurotrophic Factor in a Sample of Outpatients With Schizophrenia. Front Psychiatry 2019; 10:785. [PMID: 31708824 PMCID: PMC6823665 DOI: 10.3389/fpsyt.2019.00785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: We investigated whether levels of current physical activity (PA) contribute to the established relationship between cardiorespiratory fitness (CRF) and cognition in schizophrenia and whether brain-derived neurotrophic factor (BDNF) or its precursor proBDNF mediates this relationship. Method: Sixty-one outpatients with schizophrenia spectrum disorders participated. Neurocognition was assessed with the Wechsler Adult Intelligence Scale (WAIS) and nine subtests from the MATRICS battery comprising a neurocognitive composite score (NCS). CRF was assessed with peak oxygen uptake (VO2peak) measured directly during a maximum exercise test. Current PA levels were objectively assessed by an accelerometer worn for four consecutive days. BDNF and proBDNF were measured in fasting blood. Four serial parallel mediation analyses and two additional parallel mediation analyses were conducted, while controlling for age and sex at all levels. Results: No direct effects were found between PA measures and WAIS or NCS. No significant mediating effects of CRF or BDNF/proBDNF were detected. Conclusion: The results do not support the hypothesis that PA contributes to the naturally occurring relationship between CRF and cognition in schizophrenia or the hypothesis that BDNF or proBDNF mediates this relationship. The results arguably support the assumption that the association between CRF and cognition in schizophrenia is established developmentally early. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02205684.
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Affiliation(s)
- Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University College of Southeast Norway, Notodden, Norway
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ole Andreas Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,KG Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
| | | | - Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
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