Psychosis patients should be involved when exercise routine is being designed for them: Researchers

New Delhi, July 21

Patients recovering from a psychotic episode need to be involved when their physical exercise routine is being designed so that they find it more acceptable and viable, according to mental health researchers.

Scientists at the Schizophrenia Research Foundation (SCARF), Chennai, found in a study that psychological fears related to exercising, along with barriers such as lack of equipment or access to outdoor space, can deter patients from being physically active.

With help from physical trainers, the researchers designed an exercise routine involving simple stretching and muscle-strengthening activities, and found that these patients could perform it in the comfort of their homes and in their daily attire.

These exercises, the study’s authors said, can help make patients become brisker and more energetic.

“We found that due to their low motivation, patients would rather stop taking anti-psychotic medications than engage in exercise to reduce the weight gained as a side-effect of taking these medicines,” the study’s corresponding author R Padmavati, a psychiatrist and Director, SCARF, said.

Patients experiencing psychosis lose touch with reality. These individuals display radically changed behaviours and harbour delusional thoughts, which can sometimes be accompanied by hallucinations.

While the anti-psychotic medications prescribed by psychiatrists for treatment are scientifically proven in stabilising the patients, as a side-effect, they often put on weight.

“However, in another study, despite informing the patients of the positives, we found that they did not perform the activity suggested to them. We realised that we fail to think of their barriers to exercise, such as having a space to walk before telling them to go for regular walks,” author Vijaya Raghavan, a consultant psychiatrist, who heads the research wing of the Department of Youth Mental Health at SCARF, said.

“We, therefore, thought of co-designing a physical exercise intervention by involving the patients in the process,” he said.

The study, the first one in India to co-design a physical exercise routine for psychosis patients, was inspired by a similar 2020 research from The Royal Marsden NHS Foundation Trust, UK, involving breast cancer patients.

Published in the Asian Journal of Psychiatry in May, the study is part of a University of Warwick-India-Canada global health research group project and aimed at reducing the burden of obesity in people experiencing psychotic disorders. It was funded by the UK-based National Institute for Health Research.

U Vijayalakshmi, a psychiatric social worker and a research assistant at the foundation, and Padmavati conducted interviews (in Tamil) and focus group meetings in a set of 34 participants. Nine patients recovering from their first psychotic episode, along with their family members and mental health professionals were included.

“Some of the patients told me, ‘I’m already doing so much house work. Why are you burdening me with more work?’,” said lead author Vijayalakshmi.

A joint meeting, involving certified physical trainers to get their inputs on designing a suitable exercise routine, revealed the patients’ fears of exercising alone.

“Along with low motivation, the trainers also noticed that the patients are afraid of exercising alone, because of which there was little chance of them doing so,” Vijayalakshmi said.

“The patients wanted to exercise in their own homes in their everyday attire, rather than going to a gym. They were also more interested in performing stretches, rather than weights training. Their caregivers too were wary about using weights,” said Padmavati.

The trainers, therefore, advised designing simple, easy-to-perform exercises that would also take less time, she said.

Two videos were developed for the patients. The first had muscle-strengthening exercises, while the second had stretching ones, all demonstrated by a woman physical trainer along with verbal instructions in Tamil.

In one of the strengthening exercises, the instructor lay down on her back, knees bent vertically. She then straightened out one of her legs and lifted it up in the air till it made about a 45 degree-angle with the ground, before bringing it down to rest. After 10 repetitions, the trainer performed this exercise with her other leg.

One of the stretching exercises, as demonstrated in the second video, involved standing and bending the right leg backwards. The right arm was taken behind to grab the toes of the bent leg. The instructor maintained this position for 10 seconds, before switching over to the left leg and arm.

Together, the exercise routine lasted 30 minutes — 18 for strengthening and 12 for stretching.

Testing this video in a different set of 12 patients recovering from their first psychotic episode — 11 women and a man—the researchers found that they engaged in the exercise routine for three to five days of a week.

The participants also largely reported feeling comfortable while doing the exercises along with the ease of every day attire and privacy of doing it at home.

However, the male participant reported that he felt discouraged from performing the exercise because the demonstrator was a woman.

“We now want to create a video with a male instructor and pilot it in a larger sample, before rolling it out as part of a randomised-controlled trial. Eventually, the physical exercise intervention video can be used for a larger population, such as that of Chennai,” said Padmavati.

Raghavan said, “We also want to study how ‘implementable’ the exercise routine is, so that centres across the country, including government settings, can adopt and include it in their treatment plans.”