SeniorThesis_Volpe_Nicholas

Running head: PHYSICAL ACTIVITY AND SCHIZOPHRENIA 1
Physical Activity as a Vehicle for Improving Symptoms of Schizophrenia through Improvements
in Quality of Life
Nicholas A. Volpe
University of Maryland, College Park
I pledge on my honor that I have not given or received any unauthorized assistance on this
assignment.

PHYSICAL ACTIVITY AND SCHIZOPHRENIA 2
Abstract
This paper examines the effect of physical activity on schizophrenia with quality of life as a
mediator. Multiple scenarios include a direct relationship between the impact of physical activity
on schizophrenia and an indirect relationship between physical activity and schizophrenia
through enhanced quality of life. The research presented looks at how physical activity impacts
schizophrenia including prevention, symptoms, and treatment. Numerous studies are referenced
relating to the overall benefits of physical activity, background on schizophrenia as a
psychological disorder, how physical activity affects mental health, how physical activity affects
quality of life, and quality of life in schizophrenia patients. This will enhance the avenues for
researching schizophrenia and will improve future advancements in the field of studying mental
disorders.
Keywords: physical activity, schizophrenia, quality of life

Introduction
Schizophrenia is a maleficent mental disorder that plagues too many individuals in our
society. However, with advancements in technology and behavioral science methodology, the
capacity for studying schizophrenia is becoming greater (Walker & Tessner, 2008). An example
of this increase in capacity for researching schizophrenia includes evaluating the quality of life in
individuals undergoing treatment for schizophrenia. It is expected that the quality of life of
individuals with schizophrenia is poor; however, there is a large amount of research pertaining to
the impact of physical activity on increasing quality of life. Due to the numerous benefits
physical activity provides to the human body, it is possible such physical activity can improve
the quality of life even in schizophrenia patients, as well as improve their overall psychological
state.
There are a number of avenues to examine with regard to physical activity positively
impacting schizophrenia through improvements in quality of life. For example, it is important to
analyze a background of schizophrenia, what contributes to quality of life, the benefits of
physical activity and how quality of life is affected, challenges that are faced when dealing with
schizophrenia patients and getting them to exercise, challenges that are faced in measuring
quality of life in schizophrenia patients, and coping strategies patients use, and should use, when
dealing with their disorder. Individuals with schizophrenia also show substantial and persistent
impairments in a range of social cognitive domains including emotion processing, social
perception, attributional bias, and theory of mind which is equally important to analyze (Green &
Horan, 2010).
There are two major scenarios at play regarding the research to be presented. One
scenario describes a direct relationship between physical activity and schizophrenia. The other

scenario describes an indirect relationship between physical activity and schizophrenia through
quality of life (see Appendix A for visual representation). If physical activity does in fact have an
impact on schizophrenia, then it can be attributed to both a direct effect and an indirect effect
with quality of life as the mediator.
Schizophrenia Overview
Schizophrenia is a psychological disorder which distorts an individual’s apprehension of
reality and severely compromises their ability to function (Walker & Tessner, 2008). Typical age
of onset for this disorder is late adolescence or early adulthood, a time when most people achieve
autonomy (Walker & Tessner, 2008). Symptoms include hallucinations, bizarre movements,
posture, and rituals, and inappropriate emotional expressions (Walker & Tessner, 2008).
However, with that said, one of the more significant and horrid symptoms is the auditory
hallucinations (Picchioni & Murray, 2007). Patients with schizophrenia often hear voices in their
head that criticize and abuse them (Picchioni & Murray, 2007). These voices can speak directly
to the patient, comment on the patient’s actions, or talk to themselves about the patient
(Picchioni & Murray, 2007). It is common that the patients try and make sense of these auditory
hallucinations which leads to the bizarre movements, rituals, and inappropriate emotional
expressions (Picchioni & Murray, 2007). Such experiences, which can involve the loss of the
sense of volition and activity, or of the self’s unity, discreteness, or consistency over time, can be
difficult or even impossible for a normal person to imagine (Sass, 1987).
Emotional expression is a staple of schizophrenia and is a symptom that most laypeople
associate with the disorder. Recent research has taken a closer look at what exactly a patient with
schizophrenia goes through in terms of dealing with their emotions. Due to advancements in
behavioral and psychological brain imaging, research has shown that people dealing with

schizophrenia have the ability to experience emotion in the moment; however, they appear to
have difficulties anticipating, or conceptualizing, future experiences that may bring about
positive emotion (Kring & Caponigro, 2010). This impairment severely comprises their
motivation to have such experiences (Kring & Caponigro, 2010). Contrary to what many people
may think, individuals with schizophrenia exhibit very few outward displays of emotion (Kring
& Caponigro, 2010). Nonetheless, through self-reports, individuals with schizophrenia often
experience strong feelings in the presence of emotionally evocative stimuli or events (Kring &
Caponigro, 2010). Now that research has been presented that describes exactly how patients with
schizophrenia experience emotion, subsequent research can focus on the role of memory and
anticipation in an effort to help individuals with schizophrenia gestate positive future experiences
(Kring & Caponigro, 2010).
Treatment for schizophrenia is sporadic to say the least. In terms of measuring the
effectiveness of treatment, an individual diagnosed with schizophrenia can undergo a treatment
program that includes medication, as well as psychosocial intervention, that will cure major
symptoms associated with the disorder; however, it is likely the individual will still be unable to
socialize, make friends, finish school, or attend work (Addington, Piskulic, & Marshall, 2010).
Freedom from the symptoms of schizophrenia is known as a psychotic recovery and freedom
from the inability to socialize, make friends, finish school, or to attend work etc. is known as a
functional recovery (Addington et al., 2010). This makes treating schizophrenia extremely
difficult in that it is next to impossible for an individual diagnosed with schizophrenia to
complete a full recovery.
Psychosocial interventions provide many avenues for treatment that impact different
aspects of the disorder. There are five major types of psychosocial intervention including

Cognitive Behavior Therapy, Social Skills Training, family intervention, supported employment,
and cognitive remediation (Addington et al., 2010). Cognitive Behavior Therapy is an effective
treatment in schizophrenia in that it focuses on engagement, education, adaptation, coping
strategies, and relapse prevention all in an effort to improve symptoms, reduce relapse, and
enhance functional ability and quality of life (Addington et al., 2010). Social Skills Training is
significant in treating schizophrenia in that it focuses on social perception, social cognition, and
behavioral responding and expression (Addington et al., 2010). This psychosocial intervention
technique provides the best hope for schizophrenia patients to reach a full functional recovery.
Family intervention involves working with the family of an individual diagnosed with
schizophrenia in the early stages in order to maximize the family’s adaptive functioning,
minimize any disruption to family life, and minimize the risk of long term grief, stress, and
burden experienced by the family, ultimately increasing familial support and placing less stress
on the diagnosed individual (Addington et al., 2010). Supported employment attempts to
improve employment outcomes by focusing on future education and vocational development and
is another method for reaching a full functional recovery (Addington et al., 2010). Cognitive
remediation aids to improve symptoms of schizophrenia by utilizing paper-and-pencil tests and
individual computerized exercises that target attention, memory, and psychomotor speed
(Addington et al., 2010).
Treatment plans do not always turn out as expected. In fact, two thirds of people with
schizophrenia who are readmitted to the hospital are partially or completely non-adherent with
their medication (O’Donnell et al., 2003). O’Donnell et al. (2003) states this non-adherence can
be attributed to schizophrenia patients having different opinions from their doctor about their
treatment. This lack of concordance leads to adverse health outcomes (O’Donnell et al., 2003).

Therefore, O’Donnell et al. (2003) conducted a study to evaluate the efficacy of a treatment plan
known as compliance therapy which is used for improving adherence to prescribed drug
treatment among patients with schizophrenia. Fifty six diagnosed schizophrenia patients
participated in an intervention study (O’Donnell et al., 2003). The patients were divided up into a
compliance therapy group and a non-specific counseling group (O’Donnell et al., 2003). The
results of the study were measured in compliance with drug treatment, attitudes toward
treatment, symptomatology, insight, and quality of life after one year (O’Donnell et al., 2003).
Also measured was length of survival, bed days, and re-hospitalization rates after two years
(O’Donnell et al., 2003). The researchers concluded that compliance therapy did not confer a
major advantage over non-specific therapy after one year in any of the outcome measures
presented (O’Donnell et al., 2003). This evidence continues to illustrate the difficulties
associated with this disorder and the necessity for the continuation of research.
Given how much we know about this particular disease, it was not always considered a
psychological disorder. The beginning of the 20th century served as a time when disorders were
distinguished by brain and body (Walker & Tessner, 2008). Therefore, when schizophrenia
became the forefront of research, there was a futile debate with regards to identifying
schizophrenia as a biological disorder, involving genetic predispositions, or a psychological
disorder; biology relating to the body and psychology relating to the mind (Walker & Tessner,
2008). This debate led to significant challenges and confusion throughout the field. However,
after a number of decades it was concluded that schizophrenia is in fact a brain disorder,
although there are multiple inputs from a bioenvironmental standpoint (Walker & Tessner,
2008). This conclusion lead to a deeper understanding and has allowed for a plethora of future
research to take place. For instance, suggested future research includes a more intense focus on

the developmental stages of schizophrenia directly after suspected onset as well as factors that
may lead to an increased chance for schizophrenia (Walker & Tessner, 2008). For example,
Schiffman et al. (2001) suggest a number of early rearing factors that may contribute to the onset
of schizophrenia such as family dysfunction and parental loss or separation (Schiffman et al.,
2001). Other avenues for advancements in research include a greater focus on gene-environment
interactions (Walker & Tessner, 2008). Perhaps future research could focus on increasing the
quality of life of schizophrenia patients and using physical activity as an avenue to do so.
Quality of Life
It is no secret that there is a decreased quality of life among patients diagnosed with
schizophrenia. Kurs, Farkas, and Ritsner (2005) investigated how significant the impact of
schizophrenia on quality of life was. A study was conducted that compared schizophrenia
patients to their non-affected siblings and to a control group of healthy individuals. Each
experimental group and the control group were given two questionnaires entitled the
Tridimensional Personality Questionnaire and the Quality of Life Enjoyment and Life
Satisfaction Questionnaire (Kurs et al., 2005). The results of the study confirmed that
schizophrenia patients reported significantly poorer quality of life than their non-affected
siblings and the control group (Kurs et al., 2005). The study also found that schizophrenia
patients reported significantly higher scores in harm avoidance and reward dependence (Kurs et
al., 2005). The experimentalists concluded that the findings of the study relate to poor
satisfaction with physical health, social relationships, and subjective feelings in schizophrenia
patients (Kurs et al., 2005).
It is important to understand some of the reasons as to why patients with schizophrenia
have such negative relationships, subjective feelings, and poor satisfaction with physical health.

Kilian and Angermeyer (2004) conducted a study that examines the effects of interpersonal
differences and transitory changes of objective living conditions, clinical characteristics, and
type of psychiatric treatment on the transitory change of subjective quality of life in persons with
schizophrenia over a period of two and a half years. The results of the study were measured by
means of subjective and objective quality of life, clinical characteristics, type of neuroleptic
treatment, and outpatient treatment setting; all of which were assessed five times every six
months (Kilian & Angermeyer, 2004). The researchers of the study concluded that any change in
subjective quality of life was mainly affected by changes in indicators of objective quality of life
and not by interpersonal differences (Kilian & Angermeyer, 2004). Furthermore, the
characteristics of psychiatric treatment suggest that changing the medical and non-medical
treatment features does not have a significant impact on subjective quality of life (Kilian &
Angermeyer, 2004). Therefore, it can be concluded that factors such as clinical characteristics
and outpatient treatment setting had no effect on subjective quality of life; although, patients who
received neuroleptic treatment were found to have better subjective quality of life than patients
who received no neuroleptic treatment (Kilian & Angermeyer, 2004).
Sleepas a Major Factor
Ritsner, Kurs, Ponizovsky, and Hadjez (2004) examined the relationship between
perceived quality of life and subjective quality of sleep among schizophrenia patients and its
relation to symptom severity, side effects, and emotional distress. Subjects were evaluated for
symptom severity, adverse effects, emotional distress, quality of life, and sleep quality (Ritsner
et al., 2004). The results showed that patients recording inadequate amounts of sleep reported
lower mean scores in measures of quality of life (Ritsner et al., 2004). These particular patients
were also more depressed, experienced greater distress, and had an elevated number of adverse

effects to medication (Ritsner et al., 2004). The experimentalists concluded that there is a strong
association between quality of sleep and quality of life, depression, distress, and increased side
effects with medication (Ritsner et al., 2004).
Challenges
One of the major challenges presented with this disorder is measuring the quality of life
of schizophrenia patients and making sure they are accurate. Without an accurate way to measure
quality of life as associated with schizophrenia, there is no way to correctly evaluate effects of
treatment causing a standstill in the research. There is one main way to record quality of life and
that is through self-reports (Voruganti, Norman, Malla, & Cortese, 1997). Understandably, self-
reports from schizophrenia patients on quality of life can be skeptical to say the least. Therefore,
in order to discover if schizophrenia patients are capable of reporting their own ratings for
quality of life a study was conducted to examine the accuracy of health state descriptions from
symptomatically stable schizophrenia patients. The study involved 102 clinically stabilized
schizophrenia patients and a control group of 32 treated and recovered patients diagnosed with
depression (Voruganti et al., 1997). The subjects were asked to provide detailed descriptions of
three distinct health states associated with schizophrenia including severity of symptoms, insight,
and quality of life (Voruganti et al., 1997). The researchers interpreted the results of the study
and concluded that the experimental group, compared to the control group, was successfully able
to distinguish between the three specified health states with a great degree of ease and accuracy
(Voruganti et al., 1997). The ability for schizophrenia patients to provide accurate self-reports of
quality of life provides an added element in finding methods for treating schizophrenia
(Voruganti et al., 1997).

Another method for evaluating quality of life in patients with schizophrenia is through
the Schizophrenia Quality of Life Scale. As previously mentioned, methods for evaluating
quality of life is fairly inaccurate. Therefore, to investigate how effective the Schizophrenia
Quality of Life Scale was, a study was conducted. The objective of this study was to assess the
psychometric properties of the Schizophrenia Quality of Life Scale in Asians with schizophrenia
in Singapore (Luo, Seng, Xie, Li, & Thumboo, 2008). In order to measure the results of this
study, a consecutive sample of outpatients with schizophrenia completed the English or Chinese
version of the Schizophrenia Quality of Life Scale and a separate health survey twice during two
different clinical visits (Luo et al., 2008). The patients were also assessed for the presence, or
absence, of 22 psychiatric symptoms (Luo et al., 2008). The researchers of the study concluded
that the Schizophrenia Quality of Life Scale is in fact a valid determinant of quality of life in
schizophrenia patients (Luo et al., 2008). With this research, the Schizophrenia Quality of Life
Scale can be used in conjunction with self-report surveys to improve the effectiveness of
recording quality of life in patients with schizophrenia.
Another major challenge in dealing with schizophrenia patients is that many of them are
unaware that they have a psychological disorder and are unaware that they are experiencing
symptoms. Therefore, increasing insight of patients suffering from schizophrenia has become a
major goal over the years for psychiatrists. These psychiatrists and researchers understand that
optimizing quality of life plays a major role increasing insight and increasing the effect of
various treatment methods. Coudray et al. (2012) investigated the variation between quality of
life and level of insight. Previous research completed prior to this investigation determined that
higher levels of insight were associated with lower levels of quality of life (Coudray et al., 2002).
Twenty one schizophrenia patients participated in a study where they were given two self-

reported questionnaires (Coudray et al., 2002). The first questionnaire pertained to quality of life,
called SCHIZO-QoL, and the second questionnaire pertained to level of insight, called the
Markova and Berrios Insight Scale. The researchers of the study found that for insightful patients
there was a significant negative correlation associated with quality of life (Coudray et al., 2002).
These findings are consistent with the aforementioned previous research. This implies that
patients who are unaware of their condition have a greater quality of life, almost as if they have
an ignorance-is-bliss attitude.
Coping Strategies
Given that schizophrenia patients have a decreased quality of life on top of a threatening
psychological disorder, it is important to understand how patients diagnosed with schizophrenia
cope with the everyday hassles of living with a decreased quality of life as well as the symptoms
of schizophrenia. Coping styles are seen as having a fundamental effect on stress levels and
quality of life (Saavedra, 2012). Ritsner et al. (2003) analyzed whether different coping styles
mediate the relationship between psychopathology and related distress and the quality of life
among patients with schizophrenia. This was done by performing correlation and regression
analyses to examine the relationship among certain parameters such as quality of life,
psychopathology, psychological stress, and coping styles (Ritsner et al., 2003). The researchers
also wanted to estimate the mediating effect of coping styles on quality of life in the framework
of a distress/protection model (Ritsner et al., 2003). The researchers interpreted the results of the
study and concluded that there was a higher reported quality of life correlated with task-oriented
and avoidance-oriented coping styles (Ritsner et al., 2003). Contrariwise, emotion-oriented
coping styles showed a lower reported quality of life (Ritsner et al., 2003). The researchers also
concluded that the ability to cope with symptoms and associated distress substantially contributes

to quality of life appraisal in schizophrenia (Ritsner et al., 2003). Therefore, such coping
strategies are a necessary element to reduce the effect of schizophrenia and can help reduce the
negative influence of specific symptoms and related distress (Ritsner et al., 2003).
It is also common for patients with schizophrenia to find sanctuary in spirituality and
religiousness. Spirituality and religiousness provide coping through problem-solving strategies,
social support, and providing a sense of meaning in the midst of tragedy (Shah et al., 2011).
However, Shah et al. (2011) further examined the use of spirituality and religiousness as a
coping strategy. A study was conducted to measure spirituality and religiousness and its relation
to coping skills in patients with residual schizophrenia (Shah et al., 2011). Subjects of the study,
which included 103 individuals with residual schizophrenia, were assessed using a number of
scales and checklists provided by the World Health Organization (Shah et al., 2011). The
researchers interpreted the results of the study and found a positive correlation between aspects
of responsibility, problem-solving, distancing, confronted coping, and self-control and the
different facets of the surveys and checklists (Shah et al., 2011). In conclusion, a sound spiritual,
religious, or personal belief system is associated with active and adaptive coping skills in
subjects with residual schizophrenia (Shah et al., 2011). This method for coping in patients with
schizophrenia undoubtedly aids in better management of the disorder (Shah et al., 2011).
Impact of Physical Activity on Health
With the ability to accurately record the quality of life in patients with schizophrenia it is
now possible to examine the impact of physical activity on the quality of life in schizophrenia
patients. The effects of physical activity on the human body can be extremely beneficial. It has
been reported that physical activity can reduce a number of health risks in both healthy
individuals and those with chronic diseases (Morimoto et al., 2006). Those who are defined as

physically active individuals have a lower risk for cardiovascular disease, ischemic stroke,
diabetes mellitus, and osteoporosis (Morimoto et al., 2006). They also have a 30 to 40 percent
less chance for colon cancer and a 20 to 30 percent less chance for breast cancer (Morimoto et
al., 2006). Lynch, Cerin, Owen, and Aitken (2007) found significant improvements in quality of
life scores among schizophrenia patients after a certain amount of physical activity as opposed to
before.
It is important to understand how physical activity provides these benefits to the human
body. Blair, Jacobs, and Powell (1985) claim there are two mechanisms that are responsible for
producing these effects; direct and indirect. For example, in hypertensive individuals, physical
activity can directly improve the pathology by decreasing elevated plasma catecholamine levels
or it can indirectly improve the pathology by leading to weight loss which will result in improved
blood pressure levels (Blair et al., 1985). It is imperative that both direct and indirect
mechanisms are considered in order to see the ultimate benefits of physical activity (Blair et al.,
1985).
Research shows even low intensity exercise such as walking can be associated with better
health (Andersen, 2007). However, there is a lack of research regarding how to increase physical
activity in individuals and populations (Andersen, 2007). This can be especially difficult in
patients with schizophrenia which is extremely unfortunate in that such a simple activity can
show vast improvements. Therefore, a review was considered to see the impact of certain
interventions to improve walking on how much people walk, physical activity, fitness, disease
risk factors, and well-being (Andersen, 2007). Examples of interventions that were utilized in
this review include the implementation of bike lanes, walking paths, and recreational areas in
certain populations (Andersen, 2007). The researcher on this review concluded that interventions

can in fact increase the amount of walking in a population (Andersen, 2007). However, it has yet
to be proven whether these interventions can lower disease and mortality rates (Andersen, 2007).
Such interventions should be implemented in early treatment programs for patients with
schizophrenia in an effort to improve physical activity levels, even if it is only by a miniscule
amount because, as previously mentioned, even low intensity exercise can be associated with
better health.
A Genetic Analysis
The opportunity research in genetics provides is critical in developing the field of
schizophrenia and mental health. A number of studies have been conducted that illustrate current
strategies, findings, challenges, and future directions. For example, a study conducted by Pogue-
Geile and Yokley (2010) analyzes a severe psychopathological phenotype in family, twin, and
adoption populations. In fact, research suggests there are pathological traits in the parents of
schizophrenics, especially mothers, called schizogenic or schizophrenogenic traits (Wolman,
1965). This study emphasizes that overall genetic effects on schizophrenia are both important
and complex (Pogue-Geile & Yokley, 2010). Furthermore, results of this study, and other studies
involving the genetics of schizophrenia, are modest regardless of the ability to utilize a full range
of molecular and analytic techniques (Pogue-Geile & Yokley, 2010). Understanding the genetics
of schizophrenia is a growing field; however, new strategies give reason for optimism that our
understanding of the causes of schizophrenia will continue to increase (Pogue-Geile & Yokley,
2010).
Physical activity enhances cognitive functioning by improving executive function,
processing speed, and memory performance (Erickson et al., 2013). In schizophrenia patients,
physical activity is prescribed for its capability to enhance brain function (Erickson et al., 2013).

However, the benefits physical activity provides vary among individuals. One explanation for
this variance is genetic factors which can moderate the benefits. Brain-derived neurotrophic
factor (BDNF) is the gene responsible for the positive effects of physical activity on enhanced
learning and memory (Erickson et al., 2013). Val66Met describes an allele at amino acid valine
66, an essential amino acid, on the gene for BDNF (Erickson et al., 2013). Experimentalists
hypothesized the presence of this allele severely inhibits the improved cognitive performance
associated with physical activity and the BDNF gene (Erickson et al., 2013). A study was
conducted to test this hypothesis and to see the relationship between physical activity and
learning and memory given the presence of the Met allele. Subjects consisted of participants
from the University of Pittsburg Adult Heath and Behavior project and were instructed to
complete a physical activity questionnaire in addition to having their genomic DNA analyzed
(Erickson et al., 2013). The Val66Met allele was isolated and genotyped. Memory and learning
was also measured as the dependent variable. The results were consistent with the hypothesis
posed by the experimentalists. Subjects who carried the Met allele performed worse in categories
of learning and working memory (Erickson et al., 2013). However, what is important here is that
from the results the researchers confirmed that the BDNF gene moderated the effect of physical
activity on cognitive performance, especially working memory (Erickson et al., 2013). It was
concluded that physical activity elevates cognitive performance, yet there is significant
variability in the extent to which an individual’s cognitive ability improves due to the presence
of the Val66Met allele (Erickson et al., 2013). With increasing research and information
regarding the BDNF gene and the Val66Met allele researchers can better understand how
physical activity affects the mind and can work to intensify its effect on cognition.

Quality of Life Impact
A study was conducted to assess the association between physical activity and health
related quality of life among persons with arthritis or chronic joint systems (Abell, Hootman,
Zack, Moriarty, & Helmick, 2005). Participants consisted of 212,000 respondents in the 2001
behavioral risk factor surveillance system which is an annual population based telephone survey
(Abell et al., 2005). Subjects were given two surveys to answer truthfully. The first survey asked
participants to report their level of physical activity by selecting a description of recommended,
sufficient, or inactive according to federal activity recommendations (Abell et al., 2005). The
second survey asked participants to report their quality of life by estimating the number of
physically or mentally unhealthy days during the past 30 days (Abell et al., 2005). Of the
212,000 participants, 33 percent had arthritis (Abell et al., 2005). Subjects with arthritis reported
an average of 6.7 physically unhealthy days out of 30 and 4.9 mentally unhealthy days out of 30
(Abell et al., 2005). This compares to an average 1.8 physically unhealthy days and 2.7 mentally
unhealthy days out of 30 for subjects who did not have arthritis (see Appendix B for visual
representation). The experimentalists also found inactive men and women, or those who were
insufficient in the federal activity recommendations, were 1.2 to 2.4 times more likely to report
impaired quality of life compared to those subjects who met the recommended physical activity
requirements (Abell et al., 2005). It was concluded that participation in recommended amounts
of physical activity in individuals with arthritis was associated with fewer physically and
mentally unhealthy days on average and a decreased probability of having severely impaired
quality of life (Abell et al., 2005).
This positive correlation between physical activity and quality of life can also be applied
to breast cancer survivors. Milne, Guilfoyle, Gordon, Wallman, and Courneya (2007) conducted

a study with the purpose of examining breast cancer survivors’ perceptions of exercise and their
quality of life. Two hundred eighty nine breast cancer survivors completed a survey addressing
their attitudes toward exercise, behavior, and quality of life (Milne et al., 2007). Subjects also
completed two open-ended questions designed to explore perceptions of exercise and quality of
life throughout their cancer experience (Milne et al., 2007). The researchers found, given that
cancer survivors are faced with a number of treatment related morbidities two years post-
diagnosis, there is a need for health professionals to carefully address a cancer survivor’s
exercise needs in an attempt to help improve their quality of life (Milne et al., 2007).
Now that it has been established that increased amounts of physical activity can improve
quality of life, it is important to understand obstacles that may mediate the effects exercise has
on quality of life, especially in individuals with schizophrenia. It is important to understand these
obstacles in order to help eliminate any instances that may reduce the impact of physical activity
on quality of life. Schwartz (1999) states fatigue is major factor that mediates the effects of
exercise on quality of life. Therefore, she conducted a study with the purpose to explore the
relationship of exercise to fatigue and quality of life (Schwartz, 1999). Continuing to examine
breast cancer, in order to explore the relationship 31 subjects with breast cancer were enrolled in
a study prior to beginning chemotherapy where baseline measures were obtained (Schwartz,
1999). Subjects were then placed on an eight-week, home-based exercise training regimen
(Schwartz, 1999). Individuals battling breast cancer were chosen for this study because fatigue is
a common side effect of cancer treatment (Schwartz, 1999). The results of the study suggest that
there is an effect physical activity exhibits on quality of life (Schwartz, 1999). However, this
effect is mediated by fatigue (Schwartz, 1999). With that said, a randomized controlled clinical
trial is needed to establish confidence in these observed relationships (Schwartz, 1999). This

relates to schizophrenia in that research can now be conducted to examine obstacles, such as
fatigue, that mediate the impact of physical activity on quality of life and to find methods for
reducing these obstacles.
Discussion
In terms of quality of life, physical activity is associated with elevated mood, increased
maintenance of functional ability, and for the sake of the topic in discussion, a heightened
psychological well-being (Morimoto et al., 2006). Heesch, Burton, and Brown (2011) explain
how leisure-time physical activity aids in reducing the risk of poor mental health later on in life.
It is important to understand how physical activity leads to a heightened psychological well-
being in order to see its effects on patients with schizophrenia specifically. Barr Taylor, Sallis,
and Needle (1985) state the strongest evidence suggests that physical activity and exercise
alleviate symptoms associated with mild to moderate psychological disorders. Physical activity
and exercise also aids to improve self-image, social skills, and cognitive functioning and is a
staple in alcoholism and substance abuse programs (Barr Taylor et al., 1985). In conclusion, it
appears that physical activity and exercise directly improves the psychological state of those with
metal disorders including schizophrenia, which in turn increases overall quality of life.
Reijneveld, Westhoff, and Hopman-Rock (2003) examined the impact of a short health
education and physical exercise program on the mental health and physical activity levels of
Turkish first generation elderly immigrants currently residing in the Netherlands. The Turkish
immigrant population is of interest because Turkish immigrants are the largest immigrant group
in the Netherlands and this particular demographic is not generally impacted by health
promotions and preventative services (Reijneveld et al., 2003). A Healthy and Vital program was
generated for this study and was adopted for the subjects which consisted of Turkish born

individuals aged 45 and over living in the Netherlands (Reijneveld et al., 2003). After the
completion of the program, the overall results of the study showed large improvements in
categories of overall well-being, knowledge, and physical activity (Reijneveld et al, 2003).
However, in terms of mental well-being, subjects showed improvements, although they were
statistically insignificant (Reijneveld et al., 2003). It was also concluded that the effect of the
Healthy and Vital program was far more significant for subjects aged 55 and older compared to
subjects aged 45 to 55 (Reijneveld et al., 2003).
Conclusion
An extensive background of schizophrenia has allowed for great advancement in the field
of mental health. This background includes, but is not limited to, what causes the disorder,
symptoms associated with the disorder, and proven methods for treatment. This background,
along with a plethora of other research, has also allowed for the introduction of quality of life as
an avenue for improving schizophrenia. Furthermore, the impact physical activity has on overall
health adds yet another aspect to improving the strength of the research in the field of
schizophrenia.
The field of studying schizophrenia has come a long way in recent decades. This progress
has improved research efforts as well as methods for prevention, early detection, and treatment.
Furthermore, advancements in technology and newly learned information have paved the way
for future research. With increased knowledge of the physical and psychological benefits of
physical activity, future research can include examining the impact of physical activity on all
mental disorders, especially schizophrenia.
In conclusion, it can be confirmed, given the research presented, that physical activity is a
valid, and recommended, tool for improving schizophrenia. This positive effect is not only seen

in a direct relationship, but it is also seen in an indirect relationship through improvements in
quality of life. Therefore, it is correct to say physical activity improves quality of life, which in
turn improves conditions of schizophrenia. Physical activity should be a staple in all
schizophrenia treatment programs and should not be limited only to schizophrenia; rather, it
should be extended to all psychological disorders. With the implementation of physical activity
in the treatment of schizophrenia, the field of schizophrenia and mental health will be one step
closer to putting an end to this traumatic disorder.

References
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Appendix A
Figure 1. Representation of Direct Impact of Physical Activity on Schizophrenia
Figure 2. Representation of Direct and Indirect Impact of Physical Activity on Schizophrenia
through Quality of Life

Appendix B
Table1. Representation of Physical and Mental Health among Patients with Arthritis
Physically
Unhealthy
Days out of
30
Mentally
Unhealthy
Days out of
30
Arthritis 6.7 4.9
No
Arthritis
1.8 2.7
(Abell et al., 2005)

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