Browne Julia, Battaglini Claudio, Jarskog L Fredrik, Sheeran Paschal, Abrantes Ana M, Elliott Tonya, Gonzalez Oscar, Penn David L
Research Service, VA Providence Healthcare System, Providence, RI, USA.
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
Ment Health Phys Act. 2023 Mar;24. doi: 10.1016/j.mhpa.2023.100515. Epub 2023 Mar 27.
Persons with schizophrenia have reduced cardiorespiratory fitness (CRF), a predictor of all-cause mortality. Exercise is effective for improving CRF; however, motivational challenges affecting those with schizophrenia impact exercise engagement and maintenance. Virtual Physical Activity Can Enhance Life (Virtual PACE-Life), a multicomponent walking intervention guided by self-determination theory (SDT), was developed to target CRF in this population while addressing motivational difficulties. Virtual PACE-Life includes live video-delivered group walking sessions, Fitbit activity tracking, recommendations for home-based walking sessions, goal setting, and if-then plans. The present study was a 16-week pilot randomized controlled trial that evaluated the impact of Virtual PACE-Life against Fitbit Alone in a sample of 37 participants with schizophrenia on intermediate targets (competence, autonomy, and relatedness satisfaction, autonomous motivation), proximal outcomes (Fitbit-measured steps/day and minutes spent walking), and the primary outcome (CRF using the 6-minute walk test). Blinded research staff completed assessments at baseline, midpoint, posttest, and one-month follow-up. Analysis of covariance and hierarchical linear regression analyses were used to evaluate group differences at each timepoint controlling for baseline. Attendance at Virtual PACE-Life groups was 58% and Fitbit adherence was above 70% in both conditions. Intent-to-treat results indicated greater competence and autonomy satisfaction for Virtual PACE-Life but not in relatedness satisfaction or autonomous motivation. There were no group differences in proximal or primary outcomes during the intervention period. Completer analyses showed improvements in steps/day and autonomous motivation favoring Virtual PACE-Life. Future research is needed to maximize the exercise and CRF benefits of virtual group-based exercise for persons with schizophrenia.
精神分裂症患者的心肺适能（CRF）降低，而CRF是全因死亡率的一个预测指标。运动对改善CRF有效；然而，影响精神分裂症患者的动机挑战会影响运动参与度和维持情况。虚拟体育活动能提升生活质量（Virtual PACE-Life）是一种基于自我决定理论（SDT）的多成分步行干预措施，旨在针对该人群的CRF问题，同时解决动机方面的困难。Virtual PACE-Life包括通过实时视频进行的团体步行课程、Fitbit活动追踪、居家步行课程建议、目标设定以及“如果……那么……”计划。本研究是一项为期16周的试点随机对照试验，在37名精神分裂症患者样本中，评估了Virtual PACE-Life相对于仅使用Fitbit对中间目标（能力、自主性和关系满意度、自主动机）、近端结果（Fitbit测量的每日步数和步行时间）以及主要结果（使用6分钟步行测试的CRF）的影响。盲法研究人员在基线、中点、测试后和1个月随访时完成评估。使用协方差分析和分层线性回归分析来评估在控制基线的情况下各时间点的组间差异。在两种情况下，Virtual PACE-Life组的出勤率为58%，Fitbit的依从率均高于70%。意向性分析结果表明，Virtual PACE-Life组在能力和自主性满意度方面更高，但在关系满意度或自主动机方面并非如此。在干预期内，近端或主要结果方面没有组间差异。完成者分析显示，每日步数和自主动机方面的改善有利于Virtual PACE-Life组。未来需要开展研究，以最大化基于虚拟团体运动对精神分裂症患者的运动和CRF益处。
