Herbsleb Marco, Keller-Varady Katriona, Wobrock Thomas, Hasan Alkomiet, Schmitt Andrea, Falkai Peter, Gabriel Holger Horst Werner, Bär Karl-Jürgen, Malchow Berend
Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Jena, Germany.
Front Psychiatry. 2019 Mar 13;10:90. doi: 10.3389/fpsyt.2019.00090. eCollection 2019.
People with schizophrenia die on average 15-20 years earlier than age and gender matched controls in the general population. An essential part of this excess mortality in people with schizophrenia is caused by physical illnesses. Among the physical illnesses, cardiovascular disease (CVD) has been identified as the most common natural cause of death in up to 40-45% of the cases. Chronotropic incompetence (CI) is defined as the inability of the heart to increase its beating frequency in proportion to increased physical activity or higher metabolic demand. It is an established independent cardiovascular risk factor for major cardiac events and overall mortality and might explain adaptation intolerance of the cardiovascular system to even minor exercise courses. CI needs objective exercise testing for definitive diagnosis and therefore represents a biological marker indicating the integrity of the cardiovascular system. It was recently described in patients with schizophrenia and might help explain the reduced physical fitness in these patients and the inability of a subgroup of patients to benefit from exercise interventions. In this study, we tried to replicate the occurrence of CI in an independent sample of patients with schizophrenia and evaluated whether CI can be influenced by a continuous endurance training of 12 weeks. Therefore, we re-analyzed the fitness testing data of 43 patients with schizophrenia and 22 aged and gender matched healthy controls. Parameters of aerobic fitness and chronotropic response to exercise were calculated. Patients with schizophrenia were less physically fit than the healthy controls and displayed a significantly higher heart rate at rest. 10 of 43 patients with schizophrenia and no healthy control subject were classified as chronotropically incompetent. Chronotropic response to exercise did not change significantly after 12 weeks of continuous aerobic exercise training. No differences were observed for baseline heart rate and peak heart rate in both subgroups of schizophrenia patients. Aerobic fitness did not improve significantly in the patients with schizophrenia classified as chronotropically incompetent. Our results confirm the occurrence of CI in patients with multi-episode schizophrenia. This should be taken into account when planning an exercise or lifestyle intervention studies in this population. Schizophrenia patients with CI do not seem to benefit as well as schizophrenia patients without CI from aerobic exercise training interventions. Larger, prospective randomized controlled clinical trials with different training interventions are urgently needed to address the topic of schizophrenia patients not responding to exercise and the relationship to the illness itself.
精神分裂症患者的平均死亡年龄比普通人群中年龄和性别匹配的对照组早15至20年。精神分裂症患者这种额外死亡率的一个重要部分是由躯体疾病引起的。在躯体疾病中，心血管疾病（CVD）已被确定为高达40%至45%病例中最常见的自然死亡原因。变时性功能不全（CI）的定义是心脏无法随着体力活动增加或代谢需求提高而相应增加其跳动频率。它是主要心脏事件和总体死亡率的既定独立心血管危险因素，可能解释了心血管系统对即使是轻微运动过程的适应不耐受性。CI需要客观的运动测试来进行明确诊断，因此是指示心血管系统完整性的生物学标志物。最近在精神分裂症患者中对其进行了描述，它可能有助于解释这些患者体能下降以及部分患者无法从运动干预中获益的原因。在本研究中，我们试图在一个独立的精神分裂症患者样本中重现CI的发生情况，并评估CI是否会受到为期12周的持续耐力训练的影响。因此，我们重新分析了43例精神分裂症患者和22例年龄及性别匹配的健康对照者的体能测试数据。计算了有氧适能和运动时的变时反应参数。精神分裂症患者的体能不如健康对照者，且静息心率显著更高。43例精神分裂症患者中有10例被归类为变时性功能不全，而健康对照者中无此情况。持续有氧运动训练12周后，运动时的变时反应无显著变化。在精神分裂症患者的两个亚组中，静息心率和峰值心率均未观察到差异。被归类为变时性功能不全的精神分裂症患者的有氧适能没有显著改善。我们的结果证实了多发作型精神分裂症患者中存在CI。在为该人群规划运动或生活方式干预研究时应考虑到这一点。有CI的精神分裂症患者似乎不像没有CI的精神分裂症患者那样能从有氧运动训练干预中获益。迫切需要开展规模更大、采用不同训练干预的前瞻性随机对照临床试验，以解决精神分裂症患者对运动无反应的问题以及其与疾病本身的关系。
