The effects of physical exercises to mental state and

quality of life in patients with schizophrenia

A . A . A C I L
1
ms n , S . D O G A N
2
p h d & O . D O G A N
3
md
1
Psychiatric Nurse Practitioner (Msn), Psychiatric Department, and
2
Professor, Department of Psychiatric Nursing,
School of Nursing, and
3
Professor, Department of Psychiatry, Faculty of Medicine, Cumhuriyet University, Sivas,
Turkey
ACIL A. A., DOGAN S. & DOGAN O. (2008) Journal of Psychiatric and Mental
Health Nursing 15, 808815
The effects of physical exercises to mental state and quality of life in patients
with schizophrenia
The purpose of this study was to examine the effects of 10 weeks of physical exercises
programme on mental states and quality of life (QOL) of individuals with schizophrenia.
The study involved 30 inpatients or outpatients with schizophrenia who were assigned
randomly into aerobic exercise (n = 15) group and control (n = 15) group, participated to
the study voluntarily. There were no personal differences such as age, gender, disorder
duration, medication use between the both groups. An aerobic exercise programme was
applied to the subject group, the periods of 10 weeks as 3 days in a week. Data were
collected by using the Brief Symptom Inventory, the Scale for the Assessment of Positive
Symptoms, the Scale for the Assessment of Negative Symptoms and to the both group before
and after the exercise programme. After the 10-week aerobic exercise programmes the
subjects in the exercise programme showed signicantly decreases in the Scale for the
Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and
the Brief Symptom Inventory points and their World Health Organization Quality of Life
Scale-Turkish Version points were increased than controls. These results suggest that mild to
moderate aerobic exercise is an effective programme for decreasing psychiatric symptoms
and for increasing QOL in patients with schizophrenia.
Keywords: negative symptoms, physical exercise, positive symptoms, quality of life,
schizophrenia
Accepted for publication: 2 July 2008
Correspondence:
O. Dogan
C.U. Hastanesi
Psikiyatri ABD
TR58140
Sivas
Turkey
E-mails: ordogan@gmail.com;
odogan@cumhuriyet.edu.tr
Introduction
Recently, there has been a growing interest on the role of
physical exercise in the enhancement of physical and
mental health. The studies shows that physical activity
affects individuals physical functions in a positive way,
decreases morbidity risk of many illnesses, such as coroner
hearth disease, hypertension, stroke, type 2 diabetes melli-
tus, certain cancers, osteoporosis, obesity, and also contri-
butes positively to many physical illness treatments (Pierce
et al. 1993, Salmon 2001, Schmitz et al. 2004). Several
studies on the relationship of physical activity and mental
health showed that physical activity improves mental
health status especially had a positive effect on depres-
sion, anxiety and mental well-being (Moses et al. 1989,
Babyak et al. 2000, Mather et al. 2002, Dogan et al. 2004,
Schmitz et al. 2004). Also some studies have reported that
regular physical exercise programmes had a positive effect
on psychiatric disorders such as anxiety disorders, depres-
sion, schizophrenia, somatoform disorders, dementia and
Journal of Psychiatric and Mental Health Nursing, 2008, 15, 808815
808 2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
substance abuse (Veale et al. 1992, Palleschi et al. 1996,
Thachuk & Martin 1999, Daley 2002, Schmitz et al.
2004). There are several studies involving patients with
clinical depression and anxiety but no enough controlled
experimental studies showing the effects of physical
exercises on psychiatric disorders especially treatment and
rehabilitation of patients with schizophrenia.
Schizophrenia is a disorder characterized by a very
broad range of psychiatric symptoms and is dened by a
group of characteristic of positive or negative symptoms:
deterioration in social, occupational or interpersonal rela-
tionships. Schizophrenia is typically viewed as a chronic
disorder that has a poor long-term outcome (Andreasen
& Black 2001). This situation may lead poorly quality of
life (QOL) of patients with schizophrenia. Schizophrenic
people suffer a signicantly poorer standard of living than
others in the community do. In some studies, it has been
determined that the QOL of patients with schizophrenia
was low than normal population (Katscihnig 2000,
Pinikahana et al. 2002, Chan & Yu 2004).
A few no controlled experimental studies showed
that physical exercise has positive effects in patients with
schizophrenia (Pelham & Campagna 1991, Faulkner &
Biddle 1999, Thachuk & Martin 1999, Matthew &
Wattles 2001). In case reports, it was determined a decrease
on depressive and psychotic symptoms and psychomotor
agitations but increase on social skills of patients with
schizophrenia (Chamove 1986, Pelham & Campagna
1991, Faulkner & Sparkes 1999, Thachuk & Martin
1999). Pelham and Campagna investigated the physiologi-
cal, psychological and social effects of exercise in 40 out-
patients with schizophrenia (Pelham & Campagna 1991).
Their results indicated decreased in depressive symptoms,
increased general well-being and improved physical tness.
Antipsychotic drugs that are mainly used in schizophrenia
treatment causes decrease in relapses and hospitalizations
of patients with schizophrenia, but they cannot prevent
deterioration of social functionalities and QOL, impair-
ment of cognitive functions, job loss or decrease in work
efcacy. Besides, antipsychotic drugs have many extrapy-
ramidal and autonomic side effects. In addition, necessity
of long medication period and high medicine costs may
cause patient unable to use those medicines regularly
(Dogan et al. 2004). For those reasons, researchers indicate
that not only medication therapy itself can be sufcient but
also several treatment methods should be used in integrity.
In the literature, as positive effects of physical exercises in
patients with schizophrenia are indicated, needs for those
types of controlled studies on this subject are also empha-
sized due to especially the insufciency of performed con-
trolled studies on this subject (Artal & Sherman 1998,
Thachuk & Martin 1999). This study has been carried out
in order to show the effect of regular physical exercises
programme that was performed in a manner of 40 min
daily, 3 days in a week and for 10 weeks long on mental
states and QOL of outpatients with schizophrenia.
Methods
Participants
This study was a quasi-experimental type and was per-
formed in a psychiatry clinic of a university hospital
located in Central Anatolia region of Turkey. Sampling of
the research consists of 30 patients (15 subjects, 15 con-
trols), who had hospitalized upon the schizophrenia diag-
noses made according to Diagnostic and Statistical Manual
of Mental Disorders-Fourth Edition, who were discharged
from the hospital and followed up as outpatients between
1992 and 2005. The patients (subjects and controls) lived
in Sivas province had similar characteristics in age, gender,
disorder symptoms, and accepted to participate in the
study. Individuals, which matched all necessary criteria,
were divided by means of randomization method into two
groups as one being the subject group and the other being
control group.
All of participants (subjects and controls) were used to
antipsychotic drugs at the time of the exercise programme.
Besides this, subjects (inpatients) have been participated in
group psychotherapy.
Questions are:
1. Is there a difference between the Scale for the Assess-
ment of Positive Symptoms points of patients with
schizophrenia who participate in regular physical exer-
cise and who do not?
2. Is there a difference between the Scale for the Assess-
ment of Negative Symptoms points of patients with
schizophrenia who participate in regular physical exer-
cise and who do not?
3. Is there a difference between the Brief Symptom Inven-
tory points of patients with schizophrenia who partici-
pate in regular physical exercise and who do not?
4. Is there a difference between the World Health Organi-
zation Quality of Life Scale (WHOQOL) points of
patients with schizophrenia who participate in regular
physical exercise and who do not?
Instruments
Data were collected by means of following:
The Scale for the Assessment of Negative Symptoms
(SANS): SANS measures the level, distribution and severity
change of negative symptoms. The scale was developed by
Derogatis (1993). The validity and reliability studies in
Physical exercises in schizophrenia
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd 809
Turkey were done (Erkoc et al. 1991a). Its Cronbachs
alpha internal consistency was 0.93. It is a Likert type scale
including ve subscales and 25 items, having a score range
of 05. Those subscales investigate affective atting or
blunting, alogia, apathy-avolition, anhedonia-asociality
and attention. Total points vary between 0 and 125.
The Scale for the Assessment of Positive Symptoms
(SAPS): SAPS also measures the level and distribution of
the positive symptoms of the patients and was developed
by Andreasen (1990). Its validity and reliability studies for
Turkey were performed (Erkoc et al. 1991b). Its Cron-
bachs alpha internal consistency was 0.82. It is a Likert
type scale including four subscales and 34 items having
score range of 05. Those subscales were delusions, hallu-
cinations, bizarre behaviour and positive formal thought
disorder and inappropriate affect. Total points vary
between 0 and 170.
The Brief Symptom Inventory (BSI): BSI was used to
assess psychiatric symptoms of the patients before and after
the physical exercise programme. BSI was developed by
Derogatis (1993) and adapted to Turkish by Sahin &
Durak (1997). Its Cronbachs alpha internal consistency
was 0.95. It is an inventory Likert type consisting of totally
53 items and nine subgroups, having score range of 04. Its
point range is 0212. The higher the total points show that
the symptoms of patient are the more severe.
World Health Organization Quality of Life Scale-
Turkish Version (WHOQOL-BREF-TR): World Health
Organization developed WHOQOL in 1997. This scale,
development simultaneously by 15 academic centres
worldwide under the auspices of the World Health Orga-
nization, consists of the 26 items divided into four broad
domains: physical health, psychological health, social rela-
tions and environment and two questions relating to the
persons general perception of his/her QOL (general). For
Turkey, the validity and reliability studies of the scale were
done by Fidaner et al. (1999). Its Cronbachs alpha internal
consistency was 0.86.
Procedures
The forms were applied in consecutive order to all the
patients before the exercise programme begins. Physical
exercise programme was applied in-group to the subjects
for 10 weeks, as 3 days in a week and 40 min/day. The
exercise programme was designed by the contribution of
sport and physical education experts in a way as easing its
practicing by the patients themselves in their daily life.
Aerobic exercise was applied rst 2 weeks as 25 min/day
in order to prevent its overdoing by the patients. Each
exercise session began regularly with 10 min of limber up
gures, and then continued with 25 min of aerobic exer-
cises. Each programme session ended with 5-min cooling
down gures. Heart beat rates of individuals were mea-
sured before and after the each exercise session. In order to
prevent overdoing, attention was paid for not to exceed the
maximum pulse rate determined by using the 220-age
formula. The scales were applied to the patients in both
groups after the 10-week programme was completed.
Data analysis
The standard spss program was used in all statistical
analysis. Chi-square test was used for comparison of the
patients descriptive characteristics and Wilcoxon two
matched sample test was used for assessment of the differ-
ences between the scale average points of patients obtained
before and after the physical exercise programme within
the same group.
Results
The demographic and health characteristics of subject
and control groups were similar. Patients being the age of
2145, the mean age of subject group was 32.06 years and
that of control group was 32.66 years, and both of the
groups the majority (60%) were male. 86.7% of the subject
group and 73.3% of the control group were unemployed.
Average disorder duration of patients in the subject group
was 10.93 years and that of patients in the control group
was 9.60 years (P > 0.05). In the subject group 80% of the
patients and in the control group 93.7% of the patients
used to take their medicines regularly (P > 0.05).
It is determined that SAPS overall mean points of the
subject group were 18.20 11.79 before the exercise pro-
grammes and after 10-week exercise programmes it was
11.20 8.02, and the difference between those values was
statistically signicant (P < 0.05). On the other hand, SAPS
overall mean points of the control group were found to be
as 16.46 18.55 before the exercise programme and was
found to be 15.46 11.31 after the 10-week exercise pro-
grammes, and it was stated that the differences between
those values were not statistically signicant (P > 0.05). As
a result of the comparison performed on the SAPS sub-
groups mean points of the subject group obtained before
and after the 10-week exercise application, it was found
that illusions, delirium, hallucinations showed a statisti-
cally signicant decrease after the programme (P < 0.05),
and it was also determined that the mean points on bizarre
behaviour and positive formal thinking impairment did not
show any statistically signicant difference after the exer-
cises (P > 0.05). However, no any statistically signicant
difference was found in any subgroup mean points of the
control group (P > 0.05) (Table 1).
A. A. Acil et al.
810 2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
The Scale for the Assessment of Negative Symptoms
overall mean points of the subject group before the exercise
were found to be as 25.60 17.25, and after the 10-week
exercises programme, it was found to be as 15.20 12.28
and the difference between those values did not found to
be statistically signicant (P < 0.05). On the other hand,
SANS overall mean points of the control group before the
exercise were found to be 32.20 17.70, and it was found
to be 35.06 18.87 after the 10-week exercise period and
the difference determined between those values was not
found to be statistically signicant (P > 0.05). A statisti-
cally signicant decrease (P < 0.05) was determined in all
the subgroup mean points of the subject group related to
the physical exercises except for the alogia subgroup mean
points. However, there was no any statistically signicant
difference for the any subgroup mean points of the control
group (P > 0.05) (Table 2).
The BSI overall mean points of the subject group were
found to be 0.84 0.67 before the exercise and after the
exercise application it was found to be 0.50 0.45, and
the difference between those values was found statistically
signicant (P < 0.05). However, while the BSI overall mean
points of the control group before the exercise programme
were found to be 0.78 0.75, it was found to be
0.98 1.23 after the 10-week exercise application, and the
difference between those values was not considered to be
statistically signicant (P > 0.05). Related to the physical
exercise application, especially in somatization, interper-
sonal sensitivity, anxiety disorder and hostility subgroups
mean points and a statistically signicant decrease were
found (P < 0.05); however, the difference in obsessive
compulsive disorder, depression, phobic anxiety, paranoid
thoughts, psychosis and additional items subgroups was
not found statistically signicant (P > 0.05). The difference
Table 1
The Scale for the Assessment of Positive Symptoms (SAPS) points of both patient groups before and after 10-week exercise programme
Groups and Points
Before the exercise programme
Mean (SD)
After the exercise programme
Mean (SD)
Test
(Wilcoxon) P-value
SAPS
Subject group
Overall points 18.20 (11.79) 11.20 (8.02) 3.06 <0.05
Illusions 7.33 (6.13) 3.86 (3.62) 2.29 <0.05
Hallucinations 5.26 (5.67) 3.80 (4.63) 2.77 <0.05
Bizarre behaviour 1.40 (2.87) 1.26 (2.01) 0.17 >0.05
Positive formal thinking impairment 3.20 (4.98) 2.26 (3.03) 0.63 >0.05
Control Group
Overall points 16.46 (18.55) 15.46 (11.31) 0.74 >0.05
Illusions 5.00 (5.52) 4.93 (5.22) 0.21 >0.05
Hallucinations 5.26 (5.67) 6.26 (5.14) 1.15 >0.05
Bizarre behaviour 2.20 (3.29) 2.20 (3.46) 0.00 >0.05
Positive formal thinking impairment 3.13 (1.54) 1.40 (2.35) 1.70 >0.05
Table 2
The Scale for the Assessment of Negative Symptoms (SANS) points of both patient groups before and after 10-week exercise programme
Groups and Points
Before the exercise
programme
Mean (SD)
After the exercise
programme
Mean (SD)
Test
(Wilcoxon) P-value
SANS
Subject group
Overall points 25.60 (17.25) 15.20 (12.28) 3.29 <0.05
Emotional insensitivity 6.66 (4.54) 4.20 (2.78) 2.52 <0.05
Alogia 2.73 (3.17) 2.00 (2.23) 1.19 >0.05
Apathy 4.13 (4.08) 2.53 (3.31) 2.82 <0.05
Anhedonia 8.73 (6.26) 4.66 (4.62) 2.67 <0.05
Attention 3.40 (3.26) 1.80 (2.33) 2.68 <0.05
Control Group
Overall points 32.20 (17.77) 35.06 (18.87) 0.28 >0.05
Emotional insensitivity 9.60 (7.66) 8.46 (4.29) 1.26 >0.05
Alogia 4.33 (3.71) 4.46 (4.29) 0.47 >0.05
Apathy 4.46 (3.31) 5.06 (3.41) 1.54 >0.05
Anhedonia 11.20 (5.32) 11.93 (4.83) 0.54 >0.05
Attention 5.53 (3.35) 5.13 (3.52) 1.19 >0.05
Physical exercises in schizophrenia
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd 811
between subgroups mean points of the control group
obtained before and after the programme was not found
statistically signicant (P > 0.05) (Table 3).
On the other hand, an increase was found in the
WHOQOL-BREF-TR subgroups mean points of the
subject group after the 10-week exercise programme and a
statistically signicant increase was found especially in the
points of physical and mental domains in relation to the
physical exercise (P < 0.05); however, the increases of their
mean points in social, environmental and cultural domains
were not found statistically signicant (P > 0.05). The
difference between WHOQOL-BREF-TR subgroup mean
points of the control group before and after the programme
was not found statistically signicant (P > 0.05) (Table 3).
Discussion
Our data show that the SAPS overall mean points, illusions
and hallucinations subgroup mean points of the subject
group decreased evidently after the 10-week physical
exercise application. In some studies, a decrease in visual
hallucination but an increase in personal self-respect and
improvement in sleep quality in patients with schizophre-
nia and also an improvement in their overall behaviours
were observed at the end of the exercise programme
(Chamove 1986, Faulkner & Sparkes 1999, Daley 2002,
Challagan 2004). Yagi et al. (1992) stated that because of
the increase in their activity level patients with schizophre-
nia copy with their acute psychotic symptoms better than
depressive patients.
In our study, we found that the overall mean points
and all subgroup points were signicantly decreased after
the 10-week physical exercise application programme
except alogia subgroup mean points that reect thinking
impairment. Chamove (1986) stated that, after a regular
physical exercise applied in patients with schizophrenia,
negative symptoms of the schizophrenia such as body
movement abnormalities, irritability, depressive mood,
retardation and psychotic properties were diminished,
and on the other hand, social interest, social skills and
working capacity were improved related to the physical
exercise. Lee et al. (1993) stated that in schizophrenia, as
the increase in perceived threat, stress, tendency of being
introverted arose, physical exercise remedied this with-
drawal tendency by stimulating the patients interest in
the outside world again. In many studies, emphasizes have
been made on improvement of overall well-being, physical
activity, self-condence and concentration in patients with
schizophrenia provided by the aerobic exercise (Chamove
1986, Pelham & Campagna 1991, Faulkner & Sparkes
1999). This fact can be thought of as related to the exer-
cise process and to the participation of the patients whose
social relations had been limited due to the disorder, in a
more active, amusing group activity by relieving them
from their monotonous life and to the resultant increase in
their social interactivity.
On the other hand, no any signicant decrease was
determined in the patients alogia subgroup mean points
after the 10-week physical exercise programme (P > 0.05).
Alogia is a concept related to the cognitive functions,
describing a decrease in the amount of thoughts, impair-
ments of verbal uency and productivity (Andreasen &
Black 2001). The studies investigating the effect of physical
exercise in patients with schizophrenia emphasize that
Table 3
The Brief Symptom Inventory (BSI) and World Health Organization Quality of Life Scale-Turkish Version (WHOQOL-BREF-TR) points of both
patient groups before and after 10-week exercise programme
Groups and Points
Before the exercise
programme
Mean (SD)
After the exercise
programme
Mean (SD)
Test
(Wilcoxon) P-value
BSI
Subject group 0.84 (0.67) 0.50 (0.45) 2.66 <0.05
Control group 0.78 (0.75) 0.98 (1.23) 1.10 >0.05
WHOQOL-BREF-TR
Subject group
Physical domain 14.06 (2.05) 15.86 (2.23) 2.95 <0.05
Mental domain 13.66 (2.55) 15.73 (2.40) 3.16 <0.05
Social domain 11.20 (3.85) 12.53 (4.37) 1.01 >0.05
Environmental domain 14.73 (3.17) 15.53 (2.38) 1.26 >0.05
Cultural domain 14.33 (2.87) 15.33 (2.49) 1.53 >0.05
Control group
Physical domain 13.73 (3.69) 14.46 (3.62) 1.42 >0.05
Mental domain 14.40 (4.15) 13.60 (3.81) 1.4 >0.05
Social domain 10.93 (4.83) 10.20 (4.09) 1.28 >0.05
Environmental domain 14.86 (2.77) 14.46 (1.92) 0.60 >0.05
Cultural domain 14.53 (2.66) 13.93 (1.79) 1.19 >0.05
A. A. Acil et al.
812 2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
physical exercise has no effect on cognitive functions
(Taylor et al. 1985, Faulkner & Biddle 1999, Daley
2002).
After the 10-weekly physical exercise programmes, the
BSI overall mean points and somatization, interpersonal
insensitivity, anxiety disorder and hostility subgroup items
mean points were found to be decreased.
In schizophrenia, internal and external stress factors,
social norms and family over control leads to anxiety in
patients with schizophrenia. Daley (2002) is said that
regular physical activity performed by patients with schizo-
phrenia keeps them away from stressful stimuli by distract-
ing their attention away from those stimuli and therefore
helps to lessen their anxiety symptoms. Pelham & Campa-
gna (1991) related to one-to-one case studies carried on
with schizophrenia patients stated that aerobic exercise
provided a decrement in fears, unimportant thoughts,
anxiety and physical symptoms of anxiety but on the other
hand it provided an increment in the concentration of
patients with chronic schizophrenia.
Patients with schizophrenia due to their disorders
nature that causes suspicion and distrust feelings avoid
their environment and become socially isolated (Fortinash
& Holoday-Worret 1996). Pelham & Campagna (1991)
mentioned limited communication atmosphere with their
society of patients with schizophrenia and declared that
those exercises established a social communication atmo-
sphere in a group and that therefore they started to be
interested in daily activities instead of keep returning into
their inner world. It is thought that in relation to attention
deciency, cognitive impairment, delirium, hallucinations,
impaired reality perception causes interpersonal relations
of patients with schizophrenia become more difcult, and
that this problem might lead them to violent behaviours
(Andreasen & Black 2001). Taylor et al. (1985) stated that
physical exercise alleviates anger acutely and that it helps
them to tolerate, for the long term, their feelings of being
repressed.
In our study, an evident decrease in somatization points
of the patients was determined. The fact that the somati-
zation points of the patients decreased after the application
might be resulted from the decrease in their introverted
mood state and from the increase of their ability to express
themselves verbally better.
An increase in WHOQOL-BREF-TR subgroup mean
points of the subject group was determined after the physi-
cal exercise programme and especially a signicant level of
increase in their mental domain points was found depend-
ing on the physical exercise. In the literature, it is stated
that physical activity and regular physical exercise improve
QOL of patients with schizophrenia mentally and psy-
chologically (Faulkner & Sparkes 1999, Hutchinson et al.
1999, Mubarak et al. 2003, Chow et al. 2004). It was
stated that physical exercise rather than helping patients
with schizophrenia by means of diminishing their cognitive
malfunctioning but diminished anxiety, depression and
improved low self-condence improved QOL of patients
only by arranging their environmental conditions
(Faulkner & Sparkes 1999). Daley (2002) indicates that
physical work capacity of psychotic individuals increases
by means of physical activity, and that depending on the
continuality of regular physical exercises, those individuals
ensure their control over their weight and therefore they
improve their self-respect and that those positive changes
are reected on every aspects of their life.
Physical exercise programme applied by patients with
schizophrenia in the pattern of 10 weeks long as each
session taking 40 min/day, provided a positive effect on
QOL in patients with schizophrenia, and increased their
QOL. Exercise programme provided a signicant improve-
ment in points of physical domain consisting of overall
physical activity and in points of mental domain consisting
of emotions, cognitive functions and behaviours (P < 0.05).
This fact also observed in their SAPS, SANS and BSI points
that reects the symptoms of disorder. However, social,
environmental and cultural domains that indicate QOL
consist of the external factors that are out of individuals
control. Therefore, it is considered as a normal fact that the
application of those exercises individually without group-
ing does not lead to the sufcient improvement in those
domains.
In our study, increase in positive symptoms and decrease
in negative symptoms of the patients by means of physical
exercise application might have provided a positive effect
on improvement of their QOL. Therefore, it can be said
that physical exercise makes a positive contribution to the
QOL of patients with schizophrenia, and in case it is
used in association with the other pharmacological and
psychosocial treatment approaches, it may lead to much
more signicant improvements mental states and QOL of
patients.
After the physical exercise programme, all of the
participants have been stated that they have been more
relaxed, untroubled, powerful and healthy. Some of them
have been stated that they have been more active in daily
activities in self-care.
The patients were taking classical (haloperidol, u-
phenazine decanoate) and atypical (risperidone, olanza-
pine, quetiapine) antipsychotic agents (mean duration
10.26 7.59 years). We have not thought that the medi-
cation used affected the scores on the instruments used in
the study. On the contrary, physical exercise programme
could be enhanced the treatment compliance and social
interaction.
Physical exercises in schizophrenia
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd 813
Conclusion
The results obtained in our study show that application of
regular physical exercise practiced by patients with schizo-
phrenia is a useful non-pharmacological application to
improve their mental states and QOL. Nurses have an
active role through the integrated approach in preventing
disorders, their treatment and rehabilitation. For this
reason, psychiatric nurses is an important group serving in
encouraging inpatients to practicing physical exercise and
after their discharging from hospital, serving in adapting
those exercise applications in to daily living of patients
(Speck 2002).
Physical exercise programme is a new, cheap, effective,
easily applicable and readily available method for which
the available facilities would be sufcient as an alternative
in supporting the therapy by signicantly effecting course
of disorder both in clinical environment and after discharg-
ing of those patients. For this reason, it is thought that
in case it is used in integration with classical treatment
methods, physical exercise would make positive contribu-
tion to mental health and QOL of patients.
Our results are very difcult to generalize because of we
have been very limited amount of participant. This study
being performed with limited time, long-term consequences
of physical exercise has not been investigated. For this
reason, it may be useful to investigate its consequences on
a larger sampling and for a longer term. In this study, only
the effect of physical exercise in patients with schizophrenia
psychiatric symptoms and their QOL has been explored.
It may be recommended multidimensional studies to be
performed comparing the effect of physical exercise on
the other treatment approaches.
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