Medscape article...wt gain

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Exercise Program Reverses Antipsychotic-Induced Weight Gain

NEW YORK (Reuters Health) Jan 29 - In patients maintained on antipsychotic

medication, a supervised exercise program significantly reduces weight and

improves blood lipid profiles, a Canadian research team has found.

" It might be extremely difficult for some chronically and severely mentally

ill patients who require antipsychotic treatment to eat less and exercise more

when their treatment increases appetite and produces fatigue and sedation,

and their illnesses decrease motivation and limit social interactions and

activities, " the investigators note.

To counteract these tendencies, Dr. Angelo Tremblay at Laval University in

Quebec City and colleagues designed a behavioral weight control program that

included a 90-minute class about proper nutrition and exercise, and a

structured, supervised exercise program. Sixty-minute exercise sessions held

twice a

week included cardiovascular workouts, strength training exercises, and

flexibility and balance drills.

Dr. Tremblay's group evaluated the program in an 18-month prospective

clinical trial among patients with schizophrenia or mood disorders undergoing

treatment with atypical antipsychotic medications (olanzapine, clozapine,

risperidone or quetiapine). Fifty-nine patients were allocated to the weight

management program and 51 patients received usual psychiatric care.

Their findings appear in the Australian and New Zealand Journal of

Psychiatry, published online on December 1, 2007.

The two groups were similar in age (mean 36 years) and duration of treatment

with the current primary antipsychotic agent (2.6 years). Nearly half of the

patients were obese, and diabetes, hypertension and hypercholesterolemia were

common in both groups.

At the end of the trial, body mass index had decreased significantly in the

active group (-4.4%) and increased significantly in the control group (+5.5%,

p < .01 for difference between groups).

Likewise, subjects in the exercise group saw significant decreases in

LDL-cholesterol, total cholesterol, triglycerides, fasting glucose, and

glycosylated hemoglobin levels and increased HDL-cholesterol concentrations.

Control

group subjects had significant increases in LDL cholesterol and triglycerides,

and no improvement in fasting glucose or glycosylated hemoglobin.

" The present findings highlight the importance of an ongoing weight

management intervention including physical exercise designed specifically for

patients on antipsychotic treatment, " Dr. Tremblay and his associates conclude.

Aust NZ J Psychiatry 2007;41:980-989.

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