Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia Davy Vancampfort a,b,n , Michel Probst a,b , Thomas Scheewe c , Amber De Herdt b , Kim Sweers a , Jan Knapen a,b , Ruud van Winkel a,d , Marc De Hert a,e a University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium b Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium c University Medical Centre Utrecht, Utrecht, The Netherlands d Department of Psychiatry and Neuropsychology, EURON, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands e Faculty of Medicine, Catholic University Leuven, Leuven, Belgium article info Article history: Received 27 February 2012 Received in revised form 1 June 2012 Accepted 17 September 2012 Keywords: Physical fitness Physical activity Smoking Mental health Metabolic syndrome Schizophrenia abstract Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD), metabolic syndrome (MetS) and an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated a reduced whole body balance (p o0.001), explosive leg muscle strength (p ¼0.003), abdominal muscular endurance (p o0.001) and running speed (p o0.001). Inactive patients scored worse on most Eurofit items than patients walking for at least 30 min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness. & 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Increased rates of cardio-vascular diseases (CVD) (De Hert et al., 2009, 2011a; Mitchell et al., 2011) and associated premature mortality (Hennekens, 2007; Capasso et al., 2008) have become a major concern in patients with schizophrenia. The metabolic syndrome (MetS) is a concept that brings together a collection of abnormal clinical and metabolic findings that are predictive for CVD. These abnormal findings include dysglycemia, increased blood pressure, elevated triglyceride levels, low high- density lipoprotein cholesterol levels, and central adiposity (Alberti et al., 2006). Underlying reasons for the development of MetS in patients with schizophrenia are complex and consist of genetic risk (van Winkel et al., 2010a,b), cardio-metabolic side- effects of antipsychotic treatment (Rummel-Kluge et al., 2010; De Hert et al., 2011b,c) and an unhealthy lifestyle. Unhealthy lifestyle choices include lack of sufficient physical activity (Vancampfort et al., 2010a), poor diet (Strassnig et al., 2003) and high rates of cigarette smoking (Bobes et al., 2010). In addition, patients with schizophrenia have limited access to general somatic health care (De Hert et al., 2011b,c; Mitchell et al., 2012). In the general population, low physical activity is ranked as the fourth leading cause of global mortality (World Health Organisation, 2009) while low physical fitness has been recog- nised as a prominent behavioural risk factor for MetS and CVD and an independent risk factor of comparable importance with diabetes for all-cause mortality (Blair et al., 1996; Wei et al., 1999; Gill and Malkova, 2006). Physical fitness can be defined as a set of independent attributes which are related to the ability to perform physical activities. Some of these components (including cardio-respiratory fitness, muscular endurance, muscular strength and flexibility) are more closely related to health, while others (such as coordination and whole body balance) are more related to performance (Pate, 1998). It was demonstrated previously that in patients with schizophrenia cardio-respiratory fitness is poor Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research 0165-1781/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2012.09.026 n Corresponding author at: University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. Tel.: þ32 2 758 05 11; fax: þ32 2 759 9879. E-mail address: Davy.Vancampfort@uc-kortenberg.be (D. Vancampfort). Please cite this article as: Vancampfort, D., et al., Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with.... Psychiatry Research (2012), http://dx.doi.org/10.1016/j.psychres.2012.09.026 Psychiatry Research ] (]]]]) ]]]–]]]