Date Presented 04/06/19
Compared to the general population, patients with chronic psychiatric disorders (CPD) are more sedentary and have higher rates of somatic comorbidities. This study provides the evidence showing the high prevalence of physical fitness deficits and body composition abnormalities in patients with CPD. The findings suggest the need for OTs to provide holistic care that includes various exercise programs to moderate the client’s deficits in health-related physical fitness.
Primary Author and Speaker: Pei-Yun Wang
Additional Authors and Speakers: Eric Hwang
Contributing Authors: Sung-Lien Chien, Shang-Liang Wu, Hui-Ling Lee
PURPOSE: This study examined health-related physical fitness (HRPF) of patients with chronic psychiatric disorders (CPD). In particular, we determined the prevalence of deficits in physical fitness and abnormality in body composition.
RATIONALE: Compared to the general population, patients with CPD are more sedentary and have higher rates of somatic comorbidities. While mental symptoms remain a priority in intervention, issues related to physical health of the patients should also be addressed.
DESIGN: This was a descriptive cross-sectional study that tested HRPF of the participants using standard evaluation protocols.
PARTICIPANTS: The study included 800 individuals with CPD who were inpatients of a psychiatric center in Taiwan.
MEASURES: Measures for HRPF consisted of physical fitness and body composition. Physical fitness included the measures of upper extremity (UE) strength and endurance (30-second arm curl), lower extremity (LE) strength and endurance (30-second chair-to-stand), UE flexibility (back scratch), LE flexibility (chair sit-and-reach), cardiopulmonary endurance (2-min step), static balance (single leg stance with eyes open), and agility and dynamic balance (2.44-meter up-and-go). Body composition was tested by the InBody 230 equipment that measures body mass index (BMI), body fat percentage, waist-to-hip ratio, and skeletal muscle mass.
ANALYSIS: The prevalence of deficits in physical fitness was defined as the percentage of participants who scored “poor” or “very poor” in the measure. The prevalence of abnormality in body composition was defined as the percentage of participants who scored "high" or "low" in the measure. Multinomial logistic regression was used to determine if the occurrence of HRPF deficits correlated with specific personal or diagnostic factors.
RESULTS: Among the 800 participants, 752 completed the measures. Participants’ ages ranged from 20 to 77 (M=52.4, SD=10.3). The prevalence of physical fitness deficits includes UE strength and endurance: 69.3%, LE strength and endurance: 70.8%, UE flexibility: 44.4%, LU flexibility: 49.1%, cardiopulmonary endurance: 85.5%, static balance: 25.9%, and agility and dynamic balance: 66.1%. The prevalence of body composition abnormality includes body fat percentage (high): 72.7%, waist-to-hip ratio (high): 46.8%, and skeletal muscle mass (low): 62.3%. The BMI results show underweight: 49.52%, normal weight: 13%, and overweight or obese: 37.48%. The occurrence of the above HRPF deficits did not significantly vary with any personal or diagnostic factors (e.g., age, gender, diagnosis, age at onset). With the personal and diagnostic factors offset, BMI was negatively correlated with UE strength and endurance (p=0.035). No other significant correlations were found between the measures of physical fitness and body composition.
CONCLUSION: The overwhelmingly high prevalence of HRPF deficits was found among the clients with CPD regardless of personal or diagnostic characteristics. The findings suggest the need for both preventive and remedial approaches to moderate the clients' HRPF deficits and reduce their somatic comorbidities. Occupational therapists should implement exercise programs that have a positive and long-lasting effect on the clients' muscular and cardiopulmonary fitness and BMI, such as high intensity interval training, moderate–vigorous physical activity, and interest-sustaining activities (e.g., sports).
IMPACT STATEMENT: Health and wellness is an important outcome stated in the Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Given the high prevalence of HRPF deficits among clients with CPD, occupational therapists should adopt a holistic health promotion approach addressing both mental and physical fitness for the clients.
References
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