Exercise and Nutrition Education Improve Psychological Well-Being for People with Schizophrenia, Study Finds

Besides significant impairments in cognitive, emotional and social functioning, people with schizophrenia face numerous health challenges beyond their mental illness, including metabolic syndrome, obesity and cardiovascular disease that are partly due to the adverse effects of antipsychotic medications and a sedentary lifestyle.

Interest in nonpharmacological interventions has been increasing. Separate studies of physical exercise and nutrition education have shown benefits for managing the health outcomes of people with schizophrenia.

A study published July 26 in Archives of Psychiatric Nursing found significant improvements in healthy lifestyle behaviors and psychological well-being when both interventions were used together.

First author Sakine Firincik, Ph.D., an assistant professor in Karabük University’s Department of Psychiatric Nursing in Karabük, Turkey, and colleagues, all in Turkey, enrolled 34 people diagnosed with schizophrenia for at least three months who were living in the community.

Participants in the intervention group and the control group, 17 people each, were recruited from different programs. All were taking oral antipsychotics and had no communication barriers. About 53% of the intervention group’s members said they believed that pharmacological treatment alone was insufficient, as did about 59% of the control group.

There were two interventions: Physical exercise sessions averaging 20 to 25 minutes once a week for four weeks consisted of strength/endurance and flexibility training. Nutritional education also was provided weekly for four weeks, in 15-minute sessions.

After each physical exercise and nutrition education session, participants filled out questionnaires on their opinions about each respective intervention.

Members of the control group received their usual care.

At the end of four weeks, the exercise-and-nutrition training group scored significantly higher on scales of healthy lifestyle behaviors and psychological well-being compared with both their pretest scores and those of the control group.

A third measure, three months after the trainings ended, also found statistically significant improvements on both scales compared with pre-test scores, but they had declined since the post-test measure.

“The gains achieved immediately after the training programs (post-test) are generally associated with increased motivation and fresh knowledge. However, this effect may diminish over time in the follow-up test,” the authors write. “This may indicate that the training effect is short-lived and that reinforcement sessions are needed.”

The researchers noted that a strength of their study was the use of a multidisciplinary team that included psychiatric nurses, physical education specialists, and dietitians, which “allowed for a comprehensive approach to intervention design and implementation.”

A major limitation was a follow-up period of only three months, “restricting the ability to draw definitive conclusions about long-term outcomes.” Also, “although music was incorporated during the warm-up phase of physical exercise sessions to enhance participant motivation, its independent effect on the outcomes was not assessed,” the authors note. “For these reasons, future studies are recommended to include larger sample sizes and longer follow-up periods.”

The study did not attempt to tease out the separate effects of the two interventions, each of which was associated with benefits in multiple previously published papers, nor did the authors comment on what separate analyses might show.

The researchers write that their findings suggest several implications for psychiatric nursing practice and education. In clinical practice, nurses can integrate physical activity and basic nutritional guidance into their routine care, they note:

“These interventions not only promote physical health but also enhance patients’ self-efficacy, mood regulation, and social functioning. The inclusion of such interventions can be particularly beneficial in community mental health settings, where long-term management and psychosocial support are emphasized.”

Given that psychiatric nurses in clinical settings may not always have direct access to physical education teachers or dietitians, they add, “it is recommended that psychiatric nurses receive basic training in physical activity promotion and nutritional guidance or collaborate with relevant specialists when necessary.”

In conclusion, they write, “These findings highlight the value of holistic interventions and suggest that integrating such programs into routine psychiatric care by mental health and psychiatric nurses can significantly contribute meaningfully to the overall well-being of patients diagnosed with schizophrenia.”