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Practice of a lifestyle improvement program for mentally handicapped persons
International Congress Series 1294 (2006) 147 – 149
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Practice of a lifestyle improvement program for mentally handicapped persons Tomohisa Shibuya a,b,*, Takeshi Sassa b a
Juntendo University, Japan b ASAI Hospital, Japan
Abstract. A lifestyle improvement program was conducted for mentally handicapped persons to examine the effects of this program on those who were taking antipsychotic medication. This program was conducted for about 3months on 11 mentally handicapped persons. The following results were obtained: (a) improvement in physical self-efficacy and (b) improvement in state anxiety. Although it was not significant, the weight and amount of body fat showed a decreasing trend. D 2006 Published by Elsevier B.V. Keywords: Mentally handicapped person; Lifestyle improvement program; Physical self-efficacy; State anxiety; Feedback
1. Introduction In recent years, the improvement of not only positive symptoms, but also negative symptoms and cognitive function of schizophrenia has been expected with the introduction of new antipsychotics [1]. Therefore, medical treatment that has brought into focus the quality of life of someone with a mental disorder is very important as well as pharmacotherapy. However, the side effects of the medicine such as weight gain and hyperglycemia have created clinical problems in psychiatric care. Thus, a lifestyle improvement program was conducted for mentally handicapped persons aiming at weight reduction and the effects of the program were examined from both the physical and mental perspectives. 2. Methods Eleven subjects (M = 4, F = 7; age 46.3 F 10.1; BMI 29.56 F 23.65: schizophrenia 8, epilepsy 1, mental retardation 2, diabetes merger 4) were attending psychiatric day hospital * Corresponding author. Juntendo University, Japan. Tel./fax: +81 476 98 1033. E-mail address: [email protected] (T. Shibuya). 0531-5131/ D 2006 Published by Elsevier B.V. doi:10.1016/j.ics.2006.03.046
148
T. Shibuya, T. Sassa / International Congress Series 1294 (2006) 147–149
and taking antipsychotic medication. The lifestyle improvement program was conducted for about 3months. This study has been approved by ethical committee of ASAI Hospital and all subjects gave informed consent to participate in this study. A summary of the subjects is shown in Table 1. The lifestyle improvement program consisted of a nutritional and health education class (once a week), a cooking class (once every 2weeks) and a physical exercise class (4 times a week). In the nutritional education class, subjects learned about nutrition for healthy eating habits, etc. In the health education class, they learned about the mechanism of diabetes and hyperlipemia, etc. In the physical exercise class, they learned about the effect of exercise on health and the importance of continuing such exercise and so forth. Furthermore, in the physical exercise class, walking, jogging, tennis, volleyball, etc. were actually performed. Each session lasted 60–120 min. Measurements included weight and the amount of subcutaneous and visceral fat using X-ray computed tomography for the physical indices. For the mental indices, a physical self-efficacy test and a state anxiety test were included. Both tests were self-reported on a four-point Likert scale, with higher scores indicating greater confidence and less anxiety. Comparison examination of the effect of the program was conducted between pre- and post-programs, respectively. 3. Data analysis Data on weight, subcutaneous and visceral fat volume, the score of the physical selfefficacy test and the state anxiety test were analyzed from the baseline to the endpoint using a two-tailed paired t-test. Furthermore, in all tests, p values less than 0.05 were considered significant. 4. Results In the analysis, the data of 50% or more of participating rate to this program were used (N = 7). The significant changes seen observed are as follows: (a) improvement in physical self-efficacy (t = 3.46, p b 0.05) and (b) improvement in state anxiety (t = 2.52, p b 0.05). In contrast, although the amount of subcutaneous and visceral fat and weight were not statistically significant, both showed a decreasing tendency when looking at the data. Table 2 shows a summary of results. 5. Discussion The results of this study demonstrate that mentally handicapped persons can benefit both physically and mentally from the lifestyle improvement program. Because the weight Table 1 Summary of subjects (N = 11; M = 4, F = 7)
Mean S.D.
Age
Height
Weight
BMI
46.27 10.06
159.73 10.61
77.02 11.84
29.56 3.68
Schizophrenia 8, epilepsy 1, mental retardation 2, diabetes merger 4.
T. Shibuya, T. Sassa / International Congress Series 1294 (2006) 147–149
149
Table 2 Analysis of body weight, subcutaneous and visceral fat, physical self-efficacy, and state anxiety (N = 7)
Body weight Subcutaneous fat Visceral fat Physical self-efficacy State anxiety
Baseline Endpoint Baseline Endpoint Baseline Endpoint Baseline Endpoint Baseline Endpoint
Mean (S.D.)
t
P
75.84 74.90 135.76 136.35 92.44 85.73 15.73 17.82 21.45 24.18
1.17
n.s.
0.13
n.s.
1.33
n.s.
3.46
b0.05
2.52
b0.05
(13.47) (13.34) (39.95) (40.61) (38.24) (39.61) (3.55) (3.63) (6.39) (5.95)
and the amount of body fat decrease, confidence concerning body and exercise increases, and anxiety decreases. Similar researches [2–4] show the effect of the program from the viewpoint of weight or body fat, BMI, etc. It is suggested that this research also showed the same effect. However, the point that should be particularly noted here is the mental effect that was acquired by participating in such a program. In these mentally handicapped persons, this point is of primary importance in order to continue undergoing rehabilitation for participation in society because it leads to stabilization of psychiatric symptoms. This in turn increases confidence and decreases anxiety in mentally handicapped persons. Against this background, when measuring weight and performing the exercise therapy, we endeavored to give positive feedback when the participants experienced success or efficacy. This is one approach to a healthy mind for mentally handicapped persons, which seems to have led to such a mental change. Therefore, the method of enforcement is regarded as very important. Acknowledgements This work was supported by the psychiatric day hospital staff and senior nutritionists at ASAI Hospital. We wish to express our gratitude to them. References [1] H.Y. Meltzer, et al., The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia, Schizophr. Bull. 25 (1999) 233 – 255. [2] K.H. Littrell, et al., The effect of an educational intervention on antipsychotic-induced weight gain, J. Nurs. Scholarsh. 35 (3) (2003) 237 – 241. [3] M. Menza, et al., Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program, J. Clin. Psychiatry 65 (4) (2004) 471 – 477. [4] B. Vreeland, et al., A program for managing weight gain associated with atypical antipsychotics, Psychiatr. Serv. 54 (8) (2003) 1155 – 1157.
www.ics-elsevier.com
Practice of a lifestyle improvement program for mentally handicapped persons Tomohisa Shibuya a,b,*, Takeshi Sassa b a
Juntendo University, Japan b ASAI Hospital, Japan
Abstract. A lifestyle improvement program was conducted for mentally handicapped persons to examine the effects of this program on those who were taking antipsychotic medication. This program was conducted for about 3months on 11 mentally handicapped persons. The following results were obtained: (a) improvement in physical self-efficacy and (b) improvement in state anxiety. Although it was not significant, the weight and amount of body fat showed a decreasing trend. D 2006 Published by Elsevier B.V. Keywords: Mentally handicapped person; Lifestyle improvement program; Physical self-efficacy; State anxiety; Feedback
1. Introduction In recent years, the improvement of not only positive symptoms, but also negative symptoms and cognitive function of schizophrenia has been expected with the introduction of new antipsychotics [1]. Therefore, medical treatment that has brought into focus the quality of life of someone with a mental disorder is very important as well as pharmacotherapy. However, the side effects of the medicine such as weight gain and hyperglycemia have created clinical problems in psychiatric care. Thus, a lifestyle improvement program was conducted for mentally handicapped persons aiming at weight reduction and the effects of the program were examined from both the physical and mental perspectives. 2. Methods Eleven subjects (M = 4, F = 7; age 46.3 F 10.1; BMI 29.56 F 23.65: schizophrenia 8, epilepsy 1, mental retardation 2, diabetes merger 4) were attending psychiatric day hospital * Corresponding author. Juntendo University, Japan. Tel./fax: +81 476 98 1033. E-mail address: [email protected] (T. Shibuya). 0531-5131/ D 2006 Published by Elsevier B.V. doi:10.1016/j.ics.2006.03.046
148
T. Shibuya, T. Sassa / International Congress Series 1294 (2006) 147–149
and taking antipsychotic medication. The lifestyle improvement program was conducted for about 3months. This study has been approved by ethical committee of ASAI Hospital and all subjects gave informed consent to participate in this study. A summary of the subjects is shown in Table 1. The lifestyle improvement program consisted of a nutritional and health education class (once a week), a cooking class (once every 2weeks) and a physical exercise class (4 times a week). In the nutritional education class, subjects learned about nutrition for healthy eating habits, etc. In the health education class, they learned about the mechanism of diabetes and hyperlipemia, etc. In the physical exercise class, they learned about the effect of exercise on health and the importance of continuing such exercise and so forth. Furthermore, in the physical exercise class, walking, jogging, tennis, volleyball, etc. were actually performed. Each session lasted 60–120 min. Measurements included weight and the amount of subcutaneous and visceral fat using X-ray computed tomography for the physical indices. For the mental indices, a physical self-efficacy test and a state anxiety test were included. Both tests were self-reported on a four-point Likert scale, with higher scores indicating greater confidence and less anxiety. Comparison examination of the effect of the program was conducted between pre- and post-programs, respectively. 3. Data analysis Data on weight, subcutaneous and visceral fat volume, the score of the physical selfefficacy test and the state anxiety test were analyzed from the baseline to the endpoint using a two-tailed paired t-test. Furthermore, in all tests, p values less than 0.05 were considered significant. 4. Results In the analysis, the data of 50% or more of participating rate to this program were used (N = 7). The significant changes seen observed are as follows: (a) improvement in physical self-efficacy (t = 3.46, p b 0.05) and (b) improvement in state anxiety (t = 2.52, p b 0.05). In contrast, although the amount of subcutaneous and visceral fat and weight were not statistically significant, both showed a decreasing tendency when looking at the data. Table 2 shows a summary of results. 5. Discussion The results of this study demonstrate that mentally handicapped persons can benefit both physically and mentally from the lifestyle improvement program. Because the weight Table 1 Summary of subjects (N = 11; M = 4, F = 7)
Mean S.D.
Age
Height
Weight
BMI
46.27 10.06
159.73 10.61
77.02 11.84
29.56 3.68
Schizophrenia 8, epilepsy 1, mental retardation 2, diabetes merger 4.
T. Shibuya, T. Sassa / International Congress Series 1294 (2006) 147–149
149
Table 2 Analysis of body weight, subcutaneous and visceral fat, physical self-efficacy, and state anxiety (N = 7)
Body weight Subcutaneous fat Visceral fat Physical self-efficacy State anxiety
Baseline Endpoint Baseline Endpoint Baseline Endpoint Baseline Endpoint Baseline Endpoint
Mean (S.D.)
t
P
75.84 74.90 135.76 136.35 92.44 85.73 15.73 17.82 21.45 24.18
1.17
n.s.
0.13
n.s.
1.33
n.s.
3.46
b0.05
2.52
b0.05
(13.47) (13.34) (39.95) (40.61) (38.24) (39.61) (3.55) (3.63) (6.39) (5.95)
and the amount of body fat decrease, confidence concerning body and exercise increases, and anxiety decreases. Similar researches [2–4] show the effect of the program from the viewpoint of weight or body fat, BMI, etc. It is suggested that this research also showed the same effect. However, the point that should be particularly noted here is the mental effect that was acquired by participating in such a program. In these mentally handicapped persons, this point is of primary importance in order to continue undergoing rehabilitation for participation in society because it leads to stabilization of psychiatric symptoms. This in turn increases confidence and decreases anxiety in mentally handicapped persons. Against this background, when measuring weight and performing the exercise therapy, we endeavored to give positive feedback when the participants experienced success or efficacy. This is one approach to a healthy mind for mentally handicapped persons, which seems to have led to such a mental change. Therefore, the method of enforcement is regarded as very important. Acknowledgements This work was supported by the psychiatric day hospital staff and senior nutritionists at ASAI Hospital. We wish to express our gratitude to them. References [1] H.Y. Meltzer, et al., The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia, Schizophr. Bull. 25 (1999) 233 – 255. [2] K.H. Littrell, et al., The effect of an educational intervention on antipsychotic-induced weight gain, J. Nurs. Scholarsh. 35 (3) (2003) 237 – 241. [3] M. Menza, et al., Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program, J. Clin. Psychiatry 65 (4) (2004) 471 – 477. [4] B. Vreeland, et al., A program for managing weight gain associated with atypical antipsychotics, Psychiatr. Serv. 54 (8) (2003) 1155 – 1157.