Exercise Benefits on Psychomotor Agitation – A Pilot Study

The use of psychoactive drugs to treat or control psychological disturbances can decrease patient’s social participation. Exercise can help minimize this collateral aspect. To investigate the benefits of patients’ participation in an exercise program regarding patient’s quality of life, selfesteem, anxiety and depression. Methods: A single subject descriptive and correlational design was conducted. The subject was a 46 year-old female with medicated schizophrenic like psychomotor agitation that undergo a sixteen weeks program composed by two weeks were quality of life (WHOQOL-BREF), anxiety (Zung scale), depression (Berg scale) and self-esteem (Rosenberg scale) were assessed without the exercise program, followed by a ten week exercise program orientated by a physiotherapist and a four week period were the exercise program was conducted without the physiotherapist supervision. A decrease was noticed in the scores of the Berg scale (10 to 1) and Zung scale (37 to 33). By another side, the scores of Rosenberg scale increased (27 to 31) and the WHOQOL-BREF psychologic and environment domains also increased (58, 33 to 87, 5 and 43,75 to 56,25 respectively). It seems that the association produces positive aspects and the program is maintained even without supervision. An application of the exercise program to more patients should be considered. Susana Lourenço*, Tiago Atalaia Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa. Submission: 2 November 2016 Accepted: 7 November 2016 Published: 25 November 2016 www.ijsrm.humanjournals.com Citation: Susana Lourenço et al. Ijsrm.Human, 2016; Vol. 5 (1): 148-160. 149 INTRODUCTION Quality of life is one of the prerequisites of human dignity, encompassing a number of factors, including health (1). According to the World Health Organization (WHO), health is defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (2), a process continuous in time, not static, composed of different stages of progression and digression (1). Physical, mental and social health is thus interdependent, with equal weight on quality of life of a society (3). Mental health has not received from the medicine and society, the same interest than physical health, perhaps derived from the bias normally associated with mental affections, derived from fear and misunderstanding that have fruit since ancient times (3, 4, 5). Madness means that individuals lose their citizenship, be isolated and are excluded from society, becoming victims of their own pathology (3, 4). It is very likely that the number of cases of mentally ill grow, due to the gradual increase in world population, increased life expectancy and exacerbate social problems (3). These issues are included in the four leading causes of disability worldwide, representing a huge cost in economic terms, disability and human suffering (3). This problem and their approach have undergone changes throughout history (6). The first time that this issue was publicly discussed was the US, in 1840, where he developed a census that included the category "stupid / crazy", in order to check the frequency of mental disorders (6). In 1948, WHO for the first time includes a session about mental disorders, the sixth edition of its International Classification of Diseases system (ICD-6) (6). In 1953, the American Psychiatric Association (APA) publishes the first edition of DMS (Diagnostic and Statistical Manual of Mental Disorders) (6). The latest edition, the DMS-V, was published May 18, 2013, being the result of 12 years of research by dozens of professionals (6). Currently, there are no radiological tests, laboratory or psychometric to diagnose the disease (7). The diagnosis is a clinical history collected from the individual and / or family / caregivers, taking into account the diagnostic criteria described in Figure 1 (3, 6). The psychiatrist should be aware of relevant information and the onset of symptoms to develop a good clinical reasoning, and thus finding the clinical diagnosis of the patient (8). The detection of such diseases as early as possible is essential so that preventive measures are applied, limiting the progression of speed, always with the aim of increasing the welfare and health of the individual, offering a better quality of life (1). If patients have due regard being seen as biopsychosocial beings feel they will be built, looking for a better way the disease (1). It is important for each individual to actively participate in monitoring their health status, as well www.ijsrm.humanjournals.com Citation: Susana Lourenço et al. Ijsrm.Human, 2016; Vol. 5 (1): 148-160. 150 as your family, vital to the success of individual treatment with this type of pathology. (2, 4). This includes the important role of physical therapist (2). This must be inserted in the multidisciplinary team that works in mental health, contributing to its knowledge of the body, so you can stop the individual process of decay, caused not only by mental disorder who suffers, as the side effects of medication (2). Knowledge of this body includes exercise but also techniques that increase the driving abilities of the individual (decrease in changes in body structure and movement, as tensions, chronic muscle stiffness, abnormal breathing pattern, postural changes or difficulties in implementing some movements), assisting in the restructuring of the psychological and social aspects, and in return the body of reality, promoting their rehabilitation (3, 9, 10). The aim of this study was to verify whether the application of an exercise-based intervention could improve the rates of depression, selfesteem, anxiety and quality of life, a subject of females diagnosed with psychomotor agitation framework in the schizophrenia spectrum. Being a pilot study is relevant because it brings some benefits to physical therapists, opening doors to the emergence of new and more complex studies and new discoveries, to increase the quality of life not only of individuals with mental disorders, as well as their families. This study will combine three concepts "physiotherapy", "mental health" and "exercise", allowing differ from the intervention of physiotherapists in this unexplored field. It will be a useful work, taking into account the scarcity of studies in this area. This study reflects another mode of intervention, in addition to drug therapy for the management of anxiety and depression of a single subject, which developed schizophrenic behavior, enabling increased their self-esteem, functionality and quality of life. This is only a pioneering study, but significant, which will contribute to future investigations more complex and credible and to improve the care of users with mental disorders. It will then be addressed to the methodology of the study, which is referred to the type of study, the specific objectives of the study, the procedures that were performed, and the measuring instruments that have been used, as well as their validity data. MATERIALS AND METHODS The study on which we look back corresponds to the first level of analysis of a study of correlational, descriptive and correlational study, single subject (11). The participant is female and is 46 years old. The wearer is married and has two daughters. It's profession of seamstress, and works 10 hours a day, Monday to Saturday. With regard to his psychological state, it has some irregularities. It is marked by negative symptoms, anxiety, depression, irritability any express your mood and sleep pattern changes. Other features are highlighted www.ijsrm.humanjournals.com Citation: Susana Lourenço et al. Ijsrm.Human, 2016; Vol. 5 (1): 148-160. 151 as lack of appetite, too many concerns, decreased predisposition for social events, changes in motor coordination and motor sequence of complex movements. There are times when their status worsens, with or without episodes of life considered stressful, and other that is stable, with symptoms virtually non-existent. It is noted further that each floating does not occur at the same time. About a year and nine months, the wearer psychomotor agitation developed a framework with appearance of schizophrenia. About six months later he began to be followed at the Hospital, in the area of psychiatry. Since being medicated (Cipralex – 10 mg).The specific objective of the study is to verify that the practice of an exercise program over a period of 10 weeks back benefits in respect of indices of anxiety, depression, self-esteem and quality of life in an individual who has developed a psychomotor agitation framework with appearance schizophrenia. It is also intended to determine whether those achieved rates remain when the user performs the exercises independently, without the presence of the physiotherapist, checking whether or not it important for your motivation for the implementation of the program. To evaluate the different rates at different times of the study, four scales were used. The scale WHOQOL-BREF, which evaluates the quality of life of users, is validated for the Portuguese population and studies show that presents good levels of discriminant validity, internal consistency, test-retest stability and content validity and is an excellent tool for evaluating the quality of life nationwide (12). Scale Self-Assessment Zung Anxiety, validated for the Portuguese population, is a tool to check the level of anxiety (13). The scale was evaluated with a good reliability, validity and discrimination (14). The depressive inventory Beck assesses depression and is adapted for the Portuguese population (15). It is considered a good tool to assess the severity of depression, with good psychometric properties with regard to validity and reliability, having a high correlation with the Hamilton scale (15). The scale of self-esteem Rosenberg, developed by Rosenberg, is an instrument that assesses self-esteem. It is found validation for the Portuguese population and reflect studies that this instrument has good internal consistency (16). The data analysis was done using a statistical descriptive analysis using Excel. The participant was informed about the procedures and the study's exercise plan and then asked if wanted to be part of this research. Once you have accepted, he signed an informed consent. Upon completion of this initial phase, therapeutic intervention explained then started. The exercises were performed in the home environment, by acceptance issues and motivation on the part of the wearer. www.ijsrm.humanjournals.com Citation: Susana Lourenço et al. Ijsrm.Human, 2016; Vol. 5 (1): 148-160. 152 The data relating to the level of quality of life, self-esteem, depression and anxiety were collected at four time points T1, T2, T3 and T4. Table 1 shows schematic steps of the procedure. Table 1 Outlining the steps of the study At first (T1), the scales were applied in order to verify what level of anxiety, depression, selfesteem and quality of life of the user prior to application of the exercise program. Two weeks later (T2), the scales were reapplied to check the fluctuation of the values of these parameters, if they remain stable or not, before the start of the exercise program. It was subsequently applied for a period of 10 weeks a coordination exercise plan, three times a week. At the end of that period, it was proposed again to the user who fills up the same scales (T3). A fourth time, the user has performed for four weeks the same exercises, but without the help and presence of the therapist. The scales were applied again after the end of that period (T4). This program consisted of three stages, with total duration of about 30 minutes (Table 2). The heating initially with a duration of 5 minutes, 20 minutes coordination exercises of the upper and lower members and, finally, about 5 minutes return to calm. Heating included the active mobilization of the major joints of the body. Coordination exercises are described Appendix 1. The program involved coordination exercises for the reason of being motivating for the wearer. Figures 1 and 2 show the experimental September related to these steps (1st and 2nd stages). Finally, the return of calm to step consists of the trunk stretching exercises and upper and lower limbs. Subtitle: T (1, 2, 3 and 4) moments of application of the scales; X1 lack of exercise; X2 Implementing an exercise program for 10 weeks with the presence of the physiotherapist; X3 Implementing an exercise program for 4 weeks without the presence of the physiotherapist. T1 T2 T3 T4 www.ijsrm.humanjournals.com Citation: Susana Lourenço et al. Ijsrm.Human, 2016; Vol. 5 (1): 148-160. 153 Table 2 -Intervention planSteps