title: A behavioral weight loss intervention for persons with serious mental illness in psychiatric rehabilitation centers Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length. Effects of high aerobic intensity training in patients with schizophrenia—A controlled trial Interventions to reduce weight gain in schizophrenia. EFFECTS OF EXERCISE ON MENTAL AND PHYSICAL HEALTH PARAMETERS OF PERSONS WITH SCHIZOPHRENIA The minimal important difference in the 6-minute walk test for patients with pulmonary arterial hypertension. Pilot Study: Access to Fitness Facility and Exercise Levels in Olanzapine-Treated Patients A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study
abstract: Objective : Overweight and obesity are epidemic in population s with serious mental illnesses . We developed and pilot-tested a behavioral weight-loss intervention appropriately tailored for persons with serious mental disorders . Methods : We conducted a single-arm pilot study in two psychiatric rehabilitation day programs in Maryl and , and enrolled 63 overweight or obese adults . The 6-month intervention provided group and individual weight management and group physical activity classes . The primary outcome was weight change from baseline to 6 months . Results : A total of 64 % of those potentially eligible enrolled at the centers . The mean age was 43.7 years ; 56 % were women ; 49 % were white ; and over half had schizophrenia or a schizoaffective disorder . One-third had hypertension and one-fifth had diabetes . In total , 52 ( 82 % ) completed the study ; others were discharged from psychiatric centers before completion of the study . Average attendance across all weight management sessions was 70 % ( 87 % on days participants attended the center ) and 59 % for physical activity classes ( 74 % on days participants attended the center ) . From a baseline mean of 210.9 lbs ( s.d . 43.9 ) , average weight loss for 52 participants was 4.5 lb ( s.d . 12.8 ) ( P<0.014 ) . On average , participants lost 1.9 % of body weight . Mean waist circumference change was 3.1 cm ( s.d . 5.6 ) . Participants on average increased the distance on the 6-minute walk test by 8 % . Conclusion : This pilot study documents the feasibility and preliminary efficacy of a behavioral weight-loss intervention in adults with serious mental illness who were attendees at psychiatric rehabilitation centers . The results may have implication s for developing weight-loss interventions in other institutional setting s such as schools or nursing homes The 6-minute walk test is used in clinical practice and clinical trials of lung diseases ; however , it is not clear whether replicate tests need to be performed to assess performance . Furthermore , little is known about the impact of walking course layout on test performance . We conducted 6-minute walks on 761 patients with severe emphysema ( mean + /- SD FEV1 % predicted = 26.3 + /- 7.2 ) who were participants in the National Emphysema Treatment Trial . Four hundred seventy participants had repeated walks on a separate day . The second test was improved by an average of 7.0 + /- 15.2 % ( 66.1 + /- 146 feet , p < 0.0001 , by paired t test ) , with an intraclass correlation coefficient of 0.88 between days . The course layout had an effect on the distance walked . Participants tested on continuous ( circular or oval ) courses had a 92.2-foot longer walking distance than those tested on straight ( out and back ) courses . Course length had no significant effect on walking distance . The training effect found in these patients with severe emphysema is less than in previous reports of patients with chronic obstructive pulmonary disease . Furthermore , the layout of the track may influence the 6-minute walk performance Background : Patients with schizophrenia have a high risk of cardiovascular disease ( CVD ) . High aerobic intensity training ( HIT ) improve peak oxygen uptake ( VO2peak ) , net mechanical efficiency of walking and risk factors for CVD but has not been investigated in patients with schizophrenia . Aims : To investigate effects from HIT on VO2peak , net mechanical efficiency of walking and risk factors for CVD in patients with schizophrenia . Methods : 25 in patients ( F20–29 , ICD-10 ) were allocated to either HIT or playing computer games ( CG ) , 3 days per week for 8 weeks . HIT consisted of 4 × 4-min intervals with 3-min break periods , at 85–95 % and 70 % of peak heart rate , respectively . Results : 12 and seven patients completed HIT and CG , respectively . The baseline VO2peak in both groups combined ( n = 19 ) was 36.8 ± 8.2 ml/kg/min and 3.12 ± 0.55 l/min . The HIT group improved VO2peak by 12 % from 3.17 ± 0.59 to 3.56 ± 0.68 l/min ( P < 0.001 ) , more than the CG group ( P = 0.014 ) . Net mechanical efficiency of walking improved by 12 % in the HIT group from 19.8 ± 3.0 % to 22.2 ± 4.5 % ( P = 0.005 ) , more than the CG group ( P = 0.031 ) . The psychiatric symptoms , expressed as the Positive and Negative Syndrome Scale ( PANSS ) and the Calgary Depression Scale for Schizophrenia ( CDSS ) , did not improve in either group . Conclusions : VO2peak and net mechanical efficiency of walking improved significantly by 8 weeks of HIT . HIT should be included in rehabilitation in order to improve physical capacity and contribute risk reduction of CVD Background Weight gain is common for people with schizophrenia and this has serious implication s for health and well being . Objectives To determine the effects of both pharmacological ( excluding medication switching ) and non pharmacological strategies for reducing or preventing weight gain in people with schizophrenia . Search methods We search ed key data bases and the Cochrane Schizophrenia Group 's trials register ( April 2006 ) , reference sections within relevant papers , h and search ed key journals , and contacted the first author of each relevant study and other experts to collect further information . Selection criteria We included all clinical r and omised controlled trials comparing any pharmacological or non pharmacological intervention for weight gain  ( diet and exercise counselling ) with st and ard care or other treatments for people with schizophrenia or schizophrenia-like illnesses . Data collection and analysis We reliably selected , quality assessed and extracted data from studies . As weight is a continuous outcome measurement , weighted mean differences ( WMD ) of the change from baseline were calculated . The primary outcome measure was weight loss . Main results Twenty-three r and omised controlled trials met the inclusion criteria for this review . Five trials assessed a cognitive/behavioural intervention and eighteen assessed a pharmacological adjunct . In terms of prevention , two cognitive/behavioural trials showed significant treatment effect ( mean weight change ) at end of treatment ( n=104 , 2 RCTs , WMD -3.38 kg CI -4.2 to -2.0 ) . Pharmacological adjunct treatments were significant with a modest prevention of weight gain ( n=274 , 6 RCTs , WMD - 1.16 kg CI -1.9 to -0.4 ) . In terms of treatments for weight loss , we found significantly greater weight reduction in the cognitive behavioural intervention group ( n=129 , 3 RCTs , WMD -1.69 kg CI -2.8 to -0.6 ) compared with st and ard care . Authors ' conclusions Modest weight loss can be achieved with selective pharmacological and non pharmacological interventions . However , interpretation is limited by the small number of studies , small sample size , short study duration and by variability of the interventions themselves , their intensity and duration . Future studies adequately powered , with longer treatment duration and rigorous methodology will be needed in further evaluating the efficacy and safety of weight loss interventions for moderating weight gain . At this stage , there is insufficient evidence to support the general use of pharmacological interventions for weight management in people with schizophrenia Although the benefits of exercise are well documented , few published research studies have examined exercise in persons with schizophrenia . This pilot examined a 16-week walking program for out patients diagnosed with schizophrenia ( N = 10 ) .  Six-minute walking distance , body mass index , percent body fat and severity of psychiatric symptoms were measured . Experimental participants in the walking group experienced significant reductions in body fat ( p = 0.03 ) compared to a control group not participating in the exercises during the same time period . Experimental participants also had greater aerobic fitness , lower body mass indexes , and fewer psychiatric symptoms than controls at the conclusion of the program . Research is needed to identify effective exercise interventions and feasible delivery modalities for persons with schizophrenia in community setting RATIONALE Although commonly used as the primary outcome measure of clinical trials in pulmonary arterial hypertension ( PAH ) , the minimal important difference ( MID ) of the 6-minute walk test ( 6MWT ) has not been well defined for this population of patients . OBJECTIVES To estimate the MID in the 6MWT in patients with PAH . METHODS Study subjects from the clinical trial of tadalafil in PAH , a 16-week , parallel-group , r and omized clinical trial of patients who were treatment naive or on background therapy with an endothelin receptor antagonist , were eligible . 6MWT was performed using a st and ardized protocol . Distributional and anchor-based methods were used to estimate the MID ; the latter method used the Physical Component Summary Score ( PCS ) of the Medical Outcomes Study 36-item short form ( SF-36 ) . MEASUREMENTS AND MAIN RESULTS Four hundred five subjects were analyzed .  Domains of the SF-36 were weakly to modestly associated with 6MWT . Change in the PCS of the SF-36 was most strongly associated with change in 6MWT ( r = 0.40 , P < 0.001 ) and thus was selected as the anchor for subsequent anchor-based analyses . Distributional analyses yielded estimates of the MID ranging from 25.1 to 38.5 m , whereas anchor-based analyses yielded an estimate of 38.6 m. CONCLUSIONS Using both distributional and anchor-based methods , the estimated consensus MID in the 6MWT for PAH is approximately 33 m. These results have important implication s for ( 1 ) assessing treatment responses from clinical trials and metaanalyses of specific PAH therapy , and ( 2 ) sample size calculations for future study design Background : Increasingly alarmed by the health risks ( that is , weight gain , elevated lipids , and poor glucose tolerance ) posed by novel antipsychotic medications , clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors . Unfortunately , schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia . Objective : To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility . Methods : Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men 's Christian Association ( YMCA ) fitness facility , based on r and om allocation . The intervention included a free membership to the YMCA for 6 months , with access to all the fitness amenities and equipment . The mean dosage of olanzapine was 11.5 mg daily for the YMCA group . Results : Of the 10 subjects , 2 did not attend at all . One subject met criteria for full attendance for each of the 6 months and lost 15 kg . Dropout rates were as follows : 90 % at 6 months , 70 % at 5 months , and 40 % at 4 months . The main reason they gave for poor attendance was lack of motivation . The mean weight gain was 2 kg in the YMCA group . Conclusion : Most subjects did not regularly exercise or attend . They cited poor motivation as the main reason . The subject who exercised regularly lost a significant amount of weight Purpose . To evaluate the feasibility and effects of an exercise programme on people with severe , chronic schizophrenia . Method . A single-group , pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week , small-group aerobic exercise programme for up to 30-min each session , twice a week and a 30-min weekly walking session . Adherence was assessed by attendance , and by analysing the exercise supervisor 's comments in a programme diary and in each participant 's exercise logbook . Body weight , cardio-respiratory fitness ( VO2 max ) , walking endurance ( 6-min walk test ) and psychiatric symptoms ( the Positive and Negative Syndrome Scale ) were measured at each time point . Results . Eight participants ( 6 men , 2 women ; mean age 45 years , 9 months ( SD 10 years , 1 month ) ; mean body mass index 27.0 ( SD 4.2 ) ) attended a mean of 73%% of the scheduled exercise sessions , and 83%% of the walking sessions , with no adverse events and no dropouts . All participants displayed positive and negative behaviours during training sessions . There were significant reductions in weight ( 2.4%% ) and body mass index ( 2.2%% ) , but no changes in other measures . Conclusions . It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight
target: The 6MWD is usually negatively associated with a higher Body Mass Index , increased cigarette consumption , higher doses of antipsychotic medication and lower physical self-worth in individuals with schizophrenia .
  The 6MWT demonstrates high reliability .
  IMPLICATION S FOR REHABILITATION The Six-Minute Walk Test reliably assesses the functional exercise capacity in patients with schizophrenia .
  The impact of therapeutic interventions on patients , as measured by the 6MWT , can not be confirmed .
background: PURPOSE The six-minute walk test ( 6MWT ) is a sub-maximal exercise test measuring the distance that a patient can walk quickly in a period of 6 minutes ( 6MWD ) .
  The objectives of this systematic review are to evaluate the 6MWT 's suitability for measuring the impact of an intervention , to compare the 6MWD walked by patients with schizophrenia with data for the general population or matched controls , to identify the determinants of 6MWD and to examine the measurement properties and quality procedures of the 6MWT .