Assessing the additional impact of fitness training in depressed psychiatric patients receiving multifaceted treatment: a replicated single-subject design.

PURPOSE: Exercise has been put forward as a therapeutic means for the treatment of clinical depression. METHODS: In this study, 29 patients, all with diagnosed with mood disorder, completed daily measurements of depression and physical well-being during periods ranging from 77 to 436 days (M = 146.5). Fitness training was added to the treatment after a period and changes before (A-phase) and after (B-phase) the implementation of this training were the subject of investigation. Data were analysed by means of randomization tests with an AB-design and time-series analysis. Replication of the findings was investigated using Fisher's multiplicative method. RESULTS: Adding fitness training to the treatment of clinical depression does not systematically lead to changes in self-reported feelings of depression on top of benefits that may be due to other treatments. CONCLUSIONS: Since the present findings are not in agreement with previous studies, the absence of statistically significant changes in self-reported feelings of depression is discussed within the complexity of the 'exercise - depression' relationship in inpatient populations. These included the severity of their depression, the potential ceiling effect of a multifaceted treatment programme and the initial increase in depression due to the confrontational nature of the intervention.

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability.

PURPOSE: The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion. METHOD: Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week. RESULTS: The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82). CONCLUSIONS: The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial.

OBJECTIVE: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept. DESIGN: Randomized controlled parallel-group trial with repeated measures. SETTING: Three treatment units of a university psychiatric hospital in Belgium. SUBJECTS: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders. INTERVENTIONS: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks. OUTCOME MEASURES: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile. RESULTS: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness. CONCLUSIONS: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Improvements in physical fitness of non-psychotic psychiatric patients following psychomotor therapy programs.

AIM: To investigate the changes in physical fitness after participation in 1 of 2 psychomotor therapy programs in a sample group of non-psychotic psychiatric patients. EXPERIMENTAL DESIGN: randomized controlled parallel group trial with follow-up measures after 8 weeks and after 16 weeks. SETTING: 3 treatment units of a university psychiatric hospital in Belgium. PATIENTS: 141 (51 males, 90 females) patients with severe depressive and/or anxious symptoms, and/or personality disorders. INTERVENTIONS: patients followed a personalized psychomotor fitness program (PF), consisting of aerobic and resistance training, or a general program of psychomotor therapy (GPMT), consisting of different forms of physical exercises and relaxation training. MEASURES: the maximum dynamic strength, the strength endurance and physical work capacity at 60% and 80% of the estimated maximal heart rate reserve. RESULTS: After 8 weeks it was observed that the PF group enhanced in all parameters of cardio-respiratory as well as muscular fitness; the GPMT group had improved in 7 out of the 9 muscular fitness measurements. At the end of the 16 weeks, both groups had shown an improvement in all of the muscular fitness parameters, but only the PF group had increased in cardio-respiratory fitness. CONCLUSION: In order to improve both muscular and cardio-respiratory fitness in these patients, a balanced personalized training program, which includes aerobic and resistance training, is necessary during a period of at least 8 weeks. The less specific GPMT, when followed for a period of 16 weeks, is sufficient for improving muscular fitness and for maintaining cardio-respiratory fitness.

Changes in psychological well-being in female patients with clinically diagnosed depression: an exploratory approach in a therapeutic setting.

The objective of this exploratory one-group pretest-posttest study was to evaluate the nature of psychological change in inward depressed psychiatric patients attending multi-disciplinary treatment, including physical activity, designed to improve mental well-being. Female depressed psychiatric patients (n = 51) were examined before and after this programme over a period of 3 months. The following psychological parameters were assessed: depression, anxiety, global self-esteem, and physical self-perceptions. Depressed patients demonstrated statistically significant improvements in depression, anxiety, global self-esteem and physical self-worth (t(50) ranging from -3.76 to 4.65, all p < 0.007; ES ranging from 0.53 to -0.65). Changes in depression and anxiety displayed a strong negative correlation with changes in global self-esteem, and those changes are independent of the initial severity of the depressive symptoms ( F(2,48) ranging from 0.03 to 0.70, n.s.). Patients with greater improvement in physical self-perceptions reported greater improvement anxious symptoms then patients who did not improve. Consequently, within the limitations of the research design it can be concluded that the programme appeared successful in improving psychological well-being in female depressed patients. Results also provide preliminary insight into the potential role of the physical self in recovery.

Body experience in eating disorders before and after treatment: a follow-up study.

Since body dissatisfaction is an essential part of anorexia/bulimia nervosa, we wanted to assess the patients' body experience before and after intensive treatment. Body experience was studied in 290 eating disorder patients, admitted to a specialised unit, after six months and again after one year using the Body Attitude Test (BAT), the Eating Disorder Inventory (EDI), and the Eating Disorder Evaluation Scale (EDES). The clearly negative body experience of eating disorder patients evolved in a positive way after therapy and this improvement lasted for up to one year after admission. EDI scores and Body Mass Index at the time of admission appeared to be the strongest predictors of the total BAT score at follow-up. Although body dissatisfaction can be quite persistent in eating disorders, intensive treatment can substantially improve the patients' body experience.

The significance of body size estimation in eating disorders: its relationship with clinical and psychological variables.

OBJECTIVE: To assess the relationship between body size estimation on the one hand and clinical and psychological variables on the other. METHOD: Body size estimation was tested with the video distortion method on a life-size screen in normal women (n = 45) and compared to a total of 189 female eating disorder patients (100 with restricting anorexia nervosa, 41 with binging/purging anorexia nervosa, 48 with bulimia nervosa). The subjects' cognitive responses (what they think they really look like), affective responses (what they feel they look like), and optative responses (what they want to look like) were correlated with clinical parameters (including body composition) and with the scores on a series of self-report questionnaires assessing general psychological well-being and body experience. RESULTS: No significant relationship was found between the body size estimations and the clinical variables. The cognitive and affective responses showed a moderate relationship with self-reported body attitude. Body dissatisfaction was negatively correlated with the optative response (desired body size). DISCUSSION: This study contributes to the construct validity of the video distortion method. Body size estimation includes more than just a perceptual task. Hence, the narrow notion of body image should be replaced by the more complex construct of "body experience," the multidimensionality of which should be addressed in both research and treatment of eating-disordered patients.

Further experience with the Body Attitude Test.

The Body Attitude Test (BAT) questionnaire was specifically developed for the assessment of patients with eating disorders. To test its usefulness, the BAT was administered together with other self-report measures (Body Shape Questionnaire, Eating Disorder Inventory, Body Attitude Questionnaire, Rosenberg Self-Esteem Scale) in 69 anorectic, 26 bulimic patients and 165 female university students. The results indicate that the negative body attitude expressed on the BAT is related to other signs of negative body experience. The BAT differentiates between clinical and non-clinical subjects and between anorectics and bulimics.

Body-size estimation in eating disorders using video distortion on a life-size screen.

BACKGROUND: The video-distortion method on a life-size screen is one of the new methods to systematically study the body experience of eating-disordered patients. METHODS: Using this method, we have studied body-size estimation in female patients suffering from eating disorders: anorexia nervosa restricting type (n = 87) and mixed type (n = 34); bulimia nervosa (n = 44), and a normal control group (n = 45). Subjects had to estimate a neutral object (neutral response) and their own body size: what they think they really look like (cognitive response); what they feel they look like (affective response), and what they want to look like (optative response). RESULTS: No significant differences were found for the neutral and the cognitive response. Eating-disordered patients clearly did not overestimate their body size. The different subgroups showed interesting differences in the degree of discrepancy between cognitive and affective responses, and in the thinness of their body ideal. CONCLUSIONS: Researchers should focus on these elements of body experience, because they are clinically far more relevant than the simple question of over/underestimation.

Body composition in female anorexia nervosa patients.

For the first time, body composition has been studied in a very large sample of female anorexia nervosa patients (n 200) using two methods: anthropometry (skinfold thickness) and densitometry (underwater weighing). The concurrent validity of both methods appeared to be good (r 0.84). Although the mean percentage of body fat (13.5) in our sample corresponds with most of the previous reports, the range (4.3-24.8) is great. Our study shows that BMI is not a good measure of fatness. Age and duration of illness were not related to body fat. Percentage fat was found to be different (t 2.76, P < 0.01) according to the diagnostic subtype of anorexia nervosa: restricters (12.9) v. bingers and/or purgers (14.7).

Body size estimation in eating disorder patients: testing the video distortion method on a life-size screen.

The video distortion method on a life-size screen is a new method for studying eating disordered patients' estimations of their own body width. Testing this method in female patients (53 with anorexia nervosa, 38 with bulimia nervosa) and 36 normal females, yielded high to very high reliability scores (consistency and test-retest stability). A careful analysis of the 'just noticeable difference' showed that a 5% deviation from the undistorted image should be considered as within the range of accuracy. Taking this into account, anorectic patients appear to score below, above, as well as within the normal range. Bulimia nervosa patients are either accurate in their body estimations or overestimate their body width. All control Ss are correct in their estimations. With this method no significant differences were found between the anorectic patients and the controls. Bulimics differ significantly from anorectics and controls on their optative responses (i.e. what they wanted to look like) and their affective responses (i.e. what they felt they looked like).

Body size estimation in obese children: a controlled study with the video distortion method.

OBJECTIVE: To investigate the reliability of the video distortion method in obese children and compare their body image with the body perception of non-obese peers. DESIGN: A standardized series of body size estimations: cognitive (what subjects 'think' they look like), affective (what they 'feel' they look like), and optative (what they 'wish' to look like). SUBJECTS: Fourty-one obese children (16 boys and 25 girls, average 12 years old) and 42 age-matched control subjects. MEASUREMENTS: Comparison of percentages of deviation from the accurate body image. RESULTS: The method was shown to be sufficiently reliable in young subjects. Compared with controls, obese children were more accurate in estimating their real body width, but desired to reduce their body size by about 25%. CONCLUSION: The video distortion method can be used as a reliable instrument to assess body perception in obese children.

Influence of high-resistance and high-velocity training on sprint performance.

The purpose of this study is to analyze the effect of high-resistance (HR) and high-velocity (HV) training on the different phases of 100-m sprint performance. Two training groups (HR and HV) were compared with two control groups (RUN and PAS). The HR (N = 22) and HV group (N = 21) trained 3 d.wk-1 for 9 wk: two strength training sessions (HR or HV) and one running session. There was a run control group (RUN, N = 12) that also participated in the running sessions (1 d.wk-1) and a passive control group (PAS, N = 11). Running speed over a 100-m sprint was recorded every 2 m. By means of a principal component analysis on all speed variables, three phases were distinguished: initial acceleration (0-10 m), building-up running speed to a maximum (10-36 m), and maintaining maximum speed in the second part of the run (36-100 m). HV training resulted in improved initial acceleration (P < 0.05 compared with RUN, PAS, and HR), a higher maximum speed (P < 0.05 compared with PAS), and a decreased speed endurance (P < 0.05 compared to RUN and PAS). The HV group improved significantly in total 100 m time (P < 0.05 compared with the RUN and PAS groups). The HR program resulted in an improved initial acceleration phase (P < 0.05 compared with PAS).

Body image assessment in anorexia nervosa patients and university students by means of video distortion: a reliability study.

It is well known that anorexia nervosa is characterized by a disturbed body image. The video distortion method is one of the many methods to systematically study the perceptual aspect of this body image. Using a distorted image of her own appearance, the subject is asked to reconstruct the 'exact' measures of her body and to indicate her ideal image. The reliability of this method has been assessed in a study involving 67 anorexic patients and 105 female university students. Test--retest results within the same session and over a one-week interval were sufficiently constant. Nonetheless, for both anorexics and controls, significant differences were found between estimates with a narrowed (thin) image initially and those with a widened (fat) image initially. Both groups underestimate their body measures and only significantly differ on estimates of their ideal image, with anorexics clearly less underestimating their ideal image than students.

[Evaluation of body image perception in patients with anorexia nervosa]. / Zur Evaluation der Körperbild-Wahrnehmung bei Patienten mit Anorexia nervosa.

In the patient unit of the University Clinic for Psychiatry at Kortenberg (K.U. Leuven) Belgium and in the Psychosomatic Hospital Bad Pyrmont, which specialises in the treatment of anorexia nervosa, a great deal of attention is given to the evaluation of body image via the video-distortion technique, the video-confrontation technique and the body attitude test (a questionnaire). These different methods as well as the first findings and experiences are described.

[Goal related observation of motor behavior in psychiatry]. / Zielgerichtete Beobachtung des Bewegungsverhaltens in der Psychiatrie.

The goals to be attained by the patients frequently are determined by the various professions in psychiatry solely before the background of their various specialities. The new observation tool--LOVIPT--is aimed at enabling an integrative approach to be taken, leading from purposive observation of problem behaviour to the formulation of therapy goals. The potential range of objectives is worded in such a way that they can be taken over by other disciplines as well. Development and scientific validation are described in some detail.

[Body image and anorexia nervosa. The use of confrontation via video in psychomotor therapy]. / Image du corps et anorexie mentale. L'emploi de la confrontation par vidéo dans la thérapie psychomotrice.

The body image of the patient suffering from anorexia nervosa is not only an important diagnostic criterion, but also an important aspect of therapy. In the patient unit of the university clinic for psychiatry at Kortenberg (K.U. Leuven), which specialises in the treatment of anorexia nervosa, a great deal of attention is given to body-image through the video confrontation technique. Video recordings are made of each patient on her arrival and departure. The recordings are shown to the patient and her group and discussed afterwards. It is expected that such confrontations will improve the attitude of the patient towards her own body. In order to evaluate these possible changes, the therapist fills out questionnaires at the start and the end of the program. The results of this method are analysed in this article.

The design and testing of a wire velocimeter.

The basic principles underlying the design of a velocimeter based on an unwinding wire, for use in athletics research, are discussed. It is shown by theoretical analysis that, in order to avoid runaway effects, the tension on the wire should be either high or low but not of intermediate strength. The low tension regime is shown to be theoretically the most favourable as it combines high accuracy of speed measurements in decelerated motion with insensitivity to resonance oscillations of the wire. Practical considerations concerning the ruggedness of the apparatus, however, favour the high tension regime. A modern apparatus incorporating microprocessors and working with thin nylon wire stretched by a force of the order of 1 N, i.e. in the high tension regime, has been constructed and tested. The test results show that the velocity of decelerated motions (up to decelerations of the order of 10 m s-2) can be faithfully recorded in the velocity range 0-15 m s-1. The relative error for the measurement of constant speed up to 15 m s-1 is about one in a thousand, which is very small and practically unattainable by other methods. An application to the study of the long jump is demonstrated and validated by the use of film analysis.