Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia Davy Vancampfort a,b, ⁎, Michel Probst a,b , Thomas Scheewe c , Katrien Maurissen a , Kim Sweers a , Jan Knapen a,b , Marc De Hert a,d a University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium b Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium c University Medical Centre Utrecht, The Netherlands d Faculty of Medicine, Catholic University Leuven, Leuven, Belgium abstract article info Article history: Received 1 February 2011 Received in revised form 7 March 2011 Accepted 20 March 2011 Available online 14 April 2011 Keywords: Schizophrenia Quality of life Physical activity Functional exercise capacity Metabolic syndrome Objective: The aim of the present study was to identify if lack of physical activity participation and an impaired functional exercise capacity compared with healthy controls contributed to an impaired health related quality of life (HRQL). We also evaluated whether the presence of metabolic syndrome (MetS) could explain the variability in HRQL in patients. Method: Patients with DSM-IV schizophrenia (n = 60) and age- and gender-matched healthy controls (n = 40) completed the SF-36 quality of life scale and the Baecke Physical Activity Questionnaire and performed a 6 minute walk test (6MWT). Patients also received a fasting metabolic laboratory screening. Linear multiple regression analysis was used to assess the associations between demographical and clinical variables and HRQL outcomes. Results: Physical and mental HRQL and the Baecke and 6MWT-scores were significantly lower in patients with schizophrenia compared with matched healthy controls. When in schizophrenia patients all individual HRQL- predictors were included in a regression model, only BMI and lack of PA during leisure time remained significant predictors for physical HRQL while for mental HRQL no significant predictor remained. The impaired functional exercise capacity and the presence of MetS did not additionally explain the variance in HRQL. Conclusions: Physical HRQL in patients with schizophrenia is not only related to increased BMI but also to lack of leisure time physical activity. A reduced physical HRQL in patients with MetS appears to be related to their greater BMI, rather than to MetS per se. Present findings provide further support for routinely incorporating physical activity within rehabilitation programs and clinical assessments. © 2011 Elsevier B.V. All rights reserved. 1. Introduction With the emergence of more effective pharmacologic treatment of psychiatric symptoms in schizophrenia, increasing attention has been paid to the development of interventions targeting long-term functional and subjective outcomes, which remain poor for many patients with schizophrenia (van Os and Kapur, 2009). Health related quality of life (HRQL) is a measure of the impact of an illness and consequent treatment upon functional health status and well-being as perceived by the patient (Fontaine and Barofsky, 2001). In patients with schizophrenia symptoms (Eack and Newhill, 2007), a higher BMI (Allison et al., 2003; Strassnig et al., 2003; De Hert et al., 2006a; Faulkner et al., 2007; Kolotkin et al., 2008), waist circumference (Faulkner et al., 2007) and subjective side-effects of antipsychotic medication (Bebbington et al., 2009) need to be considered in relation to their impact on HRQL. Also a poor social network, stigma (Sibitz et al., 2010) and neuropsychological measures including verbal ability, attention, working memory and problem-solving (Kurtz and Tolman, 2011) and smoking severity (Dixon et al., 2007) are known to be related to impairments in HRQL. Previous research in the general population demonstrated that a sedentary lifestyle and a reduced functional exercise capacity impair HRQL (Hulens et al., 2002). This might be due to several physical limitations including musculoskeletal pain in the lower limbs and a reduced cardiovascular fitness (Hulens et al., 2003). In the same way, several studies indicate that the presence of metabolic syndrome (MetS) is associated with impaired HRQL (Ford and Li, 2008; Miettola et al., 2008), albeit data are inconsistent and limited by failure to adjust for obesity (Vetter et al., 2010). It is known that in high-risk groups MetS is associated with a lower physical activity participation and reduced functional exercise capacity (Gardner et al., 2006; Schizophrenia Research 129 (2011) 122–127 ⁎ Corresponding author at: University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. Tel.: + 32 2 758 05 11; fax: +32 2 759 9879. E-mail address: Davy.Vancampfort@uc-kortenberg.be (D. Vancampfort). 0920-9964/$ – see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2011.03.018 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres