Neuropsychiatric Disease and Treatment (Dec 2022)
Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies
Abstract
Urska Arnautovska,1,2 James P Kesby,3,4 Nicole Korman,1,2 Amanda L Rebar,5 Justin Chapman,2,3 Nicola Warren,1,2 Susan L Rossell,6,7 Frances L Dark,1,2 Dan Siskind1,2,4 1Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; 2Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia; 3Centre for Mental Health, Griffith University, Nathan, QLD, Australia; 4Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia; 5Motivation of Health Behaviours Lab, Appleton Institute, School of Health, Medical, and Applied Sciences; Central Queensland University, Rockhampton, QLD, Australia; 6Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia; 7Psychiatry, St Vincent’s Hospital Melbourne, Fitzroy, VIC, AustraliaCorrespondence: Urska Arnautovska, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Building 19 (Room 1MH.44.0), 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia, Tel +61 7 3176 5813, Fax +61 7 3176 2821, Email [email protected]: People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15– 20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which—based on principles of biopsychology—can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.Keywords: exercise, psychosis, autonomous motivation, behaviour change, lifestyle interventions, behavioural maintenance
