Physical activity and fitness in adolescents at risk for psychosis within the Northern Finland 1986 Birth Cohort

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Abstract

Background

Literature regarding physical activity and fitness among subjects at risk for psychosis especially in adolescents is scarce. This study evaluated the level of physical activity and cardio-respiratory fitness among subjects at risk for psychosis in a relatively large birth cohort sample.

Methods

The study population consisted of the Northern Finland Birth Cohort 1986 including 6987 adolescents who self-reported their physical activity by responding to a postal inquiry in 2001–2002 at the age of 15–16 years. Their cardiorespiratory fitness was measured in a clinical examination by a submaximal cycle ergometer test. Vulnerability to psychosis was defined in three ways: having a parent with a history of psychosis, having prodromal symptoms of psychosis measured by PROD-screen questionnaire at the age of 15–16 years or having actually developed psychosis after the field study (in 2002–2005). The Finnish Hospital Discharge Register was used to find out about parental and the individual's own psychosis.

Results

Those individuals who developed psychosis were more likely to be physically inactive (OR 3.3; CI 95% (1.4-7.9) adjusted for gender, parental socio-economic status, family structure and parents' physical activity) and to have poor cardiorespiratory fitness (OR 2.2; 95% CI 0.6-7.8 adjusted for parental socio-economic status, family structure and parents' physical activity) compared to those who did not develop psychosis.

Conclusions

Adolescents who would actually develop psychosis had a relatively low level of physical activity compared to their age mates. General recommendations for physical activity would be important for subjects at risk for developing psychosis in order to avoid detrimental effect of physical inactivity on overall health.

Introduction

People with severe mental illness have a high mortality rate. One reason for this is the relatively high prevalence of cardiovascular diseases among those affected (Brown et al., 2002, Harris and Barraclough, 1998). Major risk factors for coronary heart disease, including hypertension, obesity, hyperlipidemias, and diabetes, are more common among patients with schizophrenia than in the general population (Hennekens et al., 2005).

We do not know enough about the causes of the higher somatic morbidity and mortality of patients. There are a few studies that have examined the lifestyle of people with psychosis. The results of those studies show that people with psychotic illness have an unhealthy lifestyle. They have an unhealthy diet, take less exercise, and smoke more cigarettes than the general population (Brown et al., 1999, Daumit et al., 2005, Roick et al., 2007). Physical inactivity and poor cardiorespiratory fitness are independent predictors of cardiovascular disease mortality (Blair et al., 2001, Lee and Skerrett, 2001).

The first-degree relatives of patients with schizophrenia (Gottesman, 1991) and subjects who suffer from so-called prodromal symptoms have increased risk for psychosis. Three out of four patients with schizophrenia present prodromal symptoms before the onset of psychosis (Häfner et al., 1999). Prodromal symptoms of psychosis include symptoms such as depressive mood, anxiety, reduced energy, motivation and anergia, social withdrawal, social dysfunctioning, mistrust, reduced attention and concentration, sleeping disturbances and irritability (Yung and McGorry, 1996).

The literature regarding physical activity among subjects at risk for psychosis is insufficient, especially in adolescence when the risk period for fulminant psychosis begins. The present study explores how the levels of physical activity and cardiorespiratory fitness are associated with the risk of psychosis among adolescents. We hypothesize that subjects at risk for psychosis show a lower level of physical activity and fitness than the general population.

Section snippets

Subjects

The Northern Finland Birth Cohort (NFBC) 1986 comprises 9432 live-born children with an expected date of birth between July 1, 1985, and June 30, 1986 from the two northernmost provinces of Finland, Oulu and Lapland (Järvelin et al., 1993). The latest follow-up of this cohort was carried out between May 2001 and June 2002 when the subjects were aged 15 to 16 years. Those 9215 adolescents who were alive and whose addresses were known received a postal questionnaire including questions about their

Results

Parental risk for psychosis was discovered among 51 boys and 71 girls, whereas 3316 boys and 3549 girls did not have this risk (Table 1). Of the subjects 24% (N = 1492) reported 3–5 symptoms by a PROD-screen questionnaire, and 7% (N = 401) more than five specific symptoms. Girls reported more prodromal symptoms of psychosis than boys (p < 0.0001). Thirty-three individuals (14 boys, 19 girls) developed psychosis after the field study. Of the subjects who fell ill 9% (three out of 33) had had a

Discussion

We originally assumed that adolescents at risk for psychosis would be physically less active and have poorer fitness than the general population. Our results suggested that adolescents who later develop psychosis are three to four times more likely to be physically inactive compared to those who do not develop psychosis. This is the first study reporting such results. Also there was some evidence, though not statistically significant, that subjects who developed psychosis had poor

Role of funding source

The Academy of Finland and the Foundations had no further role in the study design; in the collection, analysis and interpretation of data; in writing the report; and in the decision to submit the paper for publication.

Contributors

Authors Moilanen, Taanila and Tammelin designed the original study from which the data was used. Authors Koivukangas, Veijola, Tammelin, Kaakinen and Mäki conducted the literature searches and planned the analyses. Author Kaakinen performed the statistical analyses. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no personal, financial, or other conflict of interest related to the contents of this manuscript.

Acknowledgements

This work was supported by grants from the Academy of Finland (Grant codes 124257, 2128181, 214273), the Signe and Ane Gyllenberg Foundation, the Sigrid Juselius Foundation and the Thule Institute.

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