ORIGINAL ARTICLE
0, MONTH 2017
Effects of an 8-Week Aerobic Dance Program
on Health-Related Fitness in Patients
With Schizophrenia
Shu-Li Cheng1 & Huey-Fang Sun2 & Mei-Ling Yeh3*
1
PhD, RN, Assistant Professor, Department of Nursing, Mackay Medical College & 2PhD, RN, Assistant Professor,
School of Nursing, National Defense Medical Center & 3PhD, MDS, RN, Professor, Graduate Institute
of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei
University of Nursing and Health Sciences.
ABSTRACT
Background: Both psychiatric symptoms and the side effects
of medication significantly affect patients with schizophrenia.
These effects frequently result in a sedentary lifestyle and weight
gain, which increase the risk of cardiovascular disease and
premature death.
Purpose: This study developed an aerobic dance program for
patients with schizophrenia and then evaluated the effect of
this program on health-related fitness outcomes.
Methods: An experimental research design was used. Sixty
patients with schizophrenia were recruited from a daycare ward
and rehabilitation center at a psychiatric hospital in Taiwan.
Paticipants were assigned randomly into an experimental group,
which received the 8-week aerobic dance program intervention,
and a control group, which received no intervention. All of the
participants were assessed in terms of the outcome variables,
which included bodyweight, body mass index, muscular endur-
ance, flexibility, and cardiorespiratory endurance. These variables
were measured before the intervention (pretest) as well as at
8 weeks (posttest) and 12 weeks (follow-up) after the in-
tervention. This study used a generalized linear model with a
generalized estimating equation method to account for the
dependence of repeated measurements and to explore the
effects of the intervention on health-related fitness outcomes.
Results: Twenty-six participants were in the experimental group,
and 28 were in the control group. Significant between-group
differences were observed at posttest and in the follow-up for
all of the health-related fitness outcomes with the exception of
muscular endurance.
Conclusions/Implications for Practice: This study suggests
that an 8-week aerobic dance program may be an effective
intervention in patients with schizophrenia in terms of improv-
ing bodyweight, body mass index, flexibility, and cardiorespira-
tory endurance for a period of at least 4 months. Furthermore,
although muscular endurance was postively affected during the
short-term period, the benefits did not extend into the follow-up
examination. On the basis of these findings, aerobic dance is
recommended as a nonpharmacological intervention for patients
with schizophrenia who are in daycare or rehabilitation settings.
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
The Journal of Nursing Research h VOL. 00, NO.
KEY WORDS:
aerobic dance, schizophrenia, muscular endurance, flexibility,
cardiorespiratory endurance.
Introduction
Schizophrenia is a serious chronic mental disease that is char-
acterized by a significant decrease in global function. Even
after treatment with antipsychotic drugs, patients with schizo-
phrenia remain at significant risk of recrudescence and mul-
tiple physical complications (Harvey, Green, Keefe, & Velligan,
2004). The mortality rate of patients with schizophrenia
compared with healthy people is two to three times higher,
and their expected life-span is 20% lower (Saha, Chant, &
McGrath, 2007). Coronary heart disease is a major cause
of death in patients with schizophrenia, with a two-fold
higher risk than in the general population (Brown, Inskip,
& Barraclough, 2000). Approximately 50%Y75% of patients
with schizophrenia have a coronary heart disease (Hennekens,
Hennekens, Hollar, & Casey, 2005). According to the World
Health Organization (2009), the risk factors that contribute
most significantly to the global mortality rate are high blood
pressure (13% of the global death toll), tobacco use (9%),
high blood sugar (6%), lack of physical activity (6%), and
being overweight or obese (5%). Together, these factors ex-
plain 38% of deaths globally. These factors increase the risk
of chronic diseases such as heart disease, diabetes, and cancer
and affect all countries (World Health Organization, 2009).
Accepted for publication: April 10, 2016
*Address correspondence to: Mei-Ling Yeh, No. 365, Ming-Te Road,
Pei-Tou District 11219, Taipei, Taiwan, ROC.
Tel: +886 (2) 2822-7101 ext. 3230;
E-mail: meiling@ntunhs.edu.tw
The authors declare no conflicts of interest.
Cite this article as:
Cheng, S. L., Sun, H. F., & Yeh, M. L. (2017). Effects of an
8-week aerobic dance program on health-related fitness in patients
with schizophrenia. The Journal of Nursing Research, 00(0),
00Y00. doi:10.1097/jnr.0000000000000200
The Journal of Nursing Research
Lack of physical activity is the fourth leading risk factor
for global mortality. Exercise is an effective way of pro-
moting wellness in people of all ages. With regular physical
activity, mental health may improve not only in the general
population but also in patients with schizophrenia (Gorczynski
& Faulkner, 2010). Many studies provide evidence that pa-
tients with schizophrenia, compared with the general pop-
ulation, are not as active and have lower levels of physical
fitness. Faulkner, Cohn, and Remington (2006) found that
only 25% of patients with schizophrenia achieved the min-
imum recommended health goal with a medium level of
physical activity. McLeod, Jaques, and Deane (2009) re-
ported that fewer than half of participants with schizophrenia
achieved the minimum amount of weekly physical activity
and that 73% maintained a body mass index (BMI) as over-
weight or obese. Ozbulut et al. (2013) found maximal aerobic
capacity, maximal anaerobic power, anaerobic capacity, and
pulmonary functions to be lower in patients with schizo-
phrenia than in healthy controls.
Whereas enforcing exercise is difficult in any population,
it is especially difficult in populations with schizophrenia.
For patients with schizophrenia in the community, the four
main barriers to doing physical activity include limited expe-
rience with physical activity, the impact of the disease, the
effects of drugs, and the impacts of anxiety and support
networks (Johnstone, Nicol, Donaghy, & Lawrie, 2009).
Lack of physical activity and high BMI are recognized con-
tributors to the elevated rates of physical morbidity and
premature mortality that have been recognized in patients
with schizophrenia (Faulkner et al., 2006).
Many studies reveal that exercise programs for patients
with mental disorders may alleviate psychiatric symptoms
(Cheng, Yeh, Chung, & Huang, 2010), decrease self-reported
symptoms of depression (Pelham & Campagna, 1991), re-
duce BMI (Beebe et al., 2005; Fogarty, Happell, &
Pinikahana, 2004; Soundy, Muhamed, Stubbs, Probst, &
Vancampfort, 2014; Vreeland et al., 2003), and improve
cardiopulmonary function (Beebe et al., 2005; Heggelund,
Nilsberg, Hoff, Morken, & Helgerud, 2011; Scheewe, Takken,
Kahn, Cahn, & Backx, 2012), muscular endurance, and
flexibility (Cheng et al., 2010; Fogarty et al., 2004). Exercise
improves not only physical health but also mental and
emotional health. It positively affects patients with schizo-
phrenia and often represents a cost-effective and useful ad-
juvant intervention (Fogarty et al., 2004). In addition,
physical activity for people who are given a diagnosis of a
serious mental illness has been shown to contribute to
achieving recovery, fostering a sense of identity, returning to
a meaningful life, achieving success, and taking control
(Cullen & McCann, 2015).
In addition, the effects of exercise have not been well
evaluated in terms of randomization and large sample sizes,
which are necessary to promote the benefits of physical ac-
tivity and to assist inactive patients with schizophrenia to
adopt healthier lifestyles. Clinical health professionals are
currently unlikely to recommend physical exercise as a
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
Shu-Li Cheng et al.
strategy to improve the mental health of psychiatric patients
(Daley, 2002). Therefore, this study designed an aerobic dance
program as an 8-week intervention for psychiatric patients to
use during the rehabilitation stage. The effect of the 8-week
aerobic dance program on health-related fitness in terms of
bodyweight, BMI, muscular endurance, flexibility, and cardio-
respiratory endurance were then assessed and analyzed.
Methods
Research Design and Setting
An experimental research design with convenience sampling
was used. Patients with schizophrenia who met the study
criteria were recruited from the daycare ward and rehabil-
itation center at a psychiatric hospital in Taiwan. Sixty par-
ticipants were initially recruited and randomly assigned into
two groups. The experimental group received an 8-week
aerobic dance program, whereas the control group did not
receive this intervention. All of the participants received
routine care, which included art therapy and video watching
programs led by nurses. All participants were assessed on the
same outcome variables, which were as follows: bodyweight,
BMI, muscular endurance, flexibility, and cardiorespiratory
endurance. These variables were measured before the in-
tervention (pretest) and at 8 weeks (posttest) and 12 weeks
(follow-up) after the intervention.
Participants
The inclusion criteria for participation were as follows: (a) at
least 18 years old; (b) a schizophrenia diagnosis that was
made in accordance with the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition; (c) being
conscious and lucid; (d) lacking physical disorders; and (e)
motivated to participate. Exclusion criteria were as follows:
(a) the presence of an acute psychosis or cognitive disability,
(b) having a severe cardiovascular disorder, and (c) changing
medication prescriptions during the study period. All par-
ticipants had a prior history of using antipsychotic drugs.
Aerobic Dance Program
According to the American College of Sports Medicine
(Thompson, Gordon, & Pescatello, 2013), the essential
components of a systematic, individualized exercise prescrip-
tion include the appropriate mode(s), intensity, duration,
frequency, and progression of physical activity. An exercise
program should include a warm-up period (5Y10 minutes), a
stimulus or conditioning phase (20Y60 minutes), and a cool-
down phase (5Y10 minutes). Cardiorespiratory, flexibility,
resistance training, and a balance program should be integral
parts of a comprehensive exercise training program. Flexi-
bility may be incorporated into the warm-up and/or cool-
down phase. The program used in this study consisted of one
orientation and a series of structured sessions, which ran for
60 minutes each, twice per week for 8 weeks.
Aerobic Dance Program for Patients With Schizophrenia
The exercise prescription was standardized to mode (aerobic
dance), frequency (two times per week), intensity (60%Y79%
of each participant’s predicted maximal heart rate), and time
(progressing from 30 minutes of continuous main exercise). In
addition, there was a warm-up of 5Y10 minutes of gymnastics
or joint stretching, a 30-minute main exercise period to provide
target heart rates as a guide for intensity, and 5Y10 minutes
of cooldown and stretching to slow the metabolic pace to the
normal heart rhythm. The aerobic dance used gradually
advancing instructions, including posture, movements, and
stretching techniques. The aerobic dance program was led by
a professional instructor who held several certifications in
exercise instruction, was a former fitness professional and
personal training instructor at YMCA in the United States,
was a former square-dance instructor in Japan, and currently
worked as a fitness instructor for older adults at the Aerobic
Fitness and Health Association in Taiwan.
Assessment Measures
The health-related fitness measures involved the four com-
ponents of body composition, muscular endurance, flexibil-
ity, and cardiorespiratory endurance. The physical fitness
status of participants was measured at pretest, posttest, and
follow-up.
Body composition
Body composition included bodyweight, as measured using
a digital weight scale, and BMI, which was defined as weight
(kilograms)/height (square meters). Height in inches and weight
in kilograms were used for calculations, which was further
classified into underweight, normal weight, overweight, and
obese in accordance with the current standards of the
Ministry of Health and Welfare of Taiwan for Taiwanese
(BMI G 18.5 kg/m2: underweight, 18.5Y23.9 kg/m2: normal
weight, 24Y26.9 kg/m2: overweight, and 927 kg/m2: obese).
Muscular endurance
The 1-minute flexed leg sit-up was used to test abdominal
muscle strength and endurance, with the total number of sit-
ups performed within 1 minute being recorded. Subjects lay
down on a mat with their knees bent at right angles, feet flat
on the ground, and hands crossed at the shoulders in front of
the chest. The evaluation was based on the normative data
for Taiwanese (aged from 45 to 49 years; poor: e19, fair:
20Y23, good: 24Y27, very good: 28Y32, and excellent: Q33
for men; poor: e11, fair: 12Y15, good: 16Y19, very good:
22Y24, and excellent: Q25 for women; Department of
Physical Fitness Website, Ministry of Education, Taiwan,
ROC, 2014a).
Flexibility
The sit-and-reach test was used to measure lower back and
hip joint flexibility. This test is scored as the most distant
point (in centimeters) reached on the ruler with the fingertips.
A specially constructed sit-and-reach box was used with a
measuring scale where 25 cm is marked at the level of the feet.
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 00, NO. 0, MONTH 2017
Each participant was given three trials, and the best result was
recorded (Department of Physical Fitness Website, Ministry
of Education, Taiwan, ROC, 2014b). The evaluation was
based on the normative data for Taiwanese (aged from 45
to 49 years; poor: e12, fair: 12.1Y18, good: 18.1Y24, very
good: 24.1Y30, and excellent: Q30.1 for men; poor: e17,
fair: 17.1Y24, good: 24.1Y29, very good: 29.1Y36.0, and
excellent: Q36.1 for women; Department of Physical Fitness
Website, Ministry of Education, Taiwan, ROC, 2014c).
Cardiorespiratory endurance
Cardiorespiratory endurance was measured using a 3-minute
step test. Participants were asked to step at a pace of 24 times
up and down the box per minute (metronome = 96 beats per
minute), with 35-cm step box for 3 minutes to evaluate
cardiorespiratory endurance. The heart rate was measured
at three time points after this test finished: at 1Y1.5 minutes
posttest, at 2Y2.5 minutes posttest, and at 3Y3.5 minutes
posttest. The evaluation was based on the normative data for
Taiwanese (aged from 45 to 49 years; poor: e48.1, fair:
48.2Y52.9, good: 53.0Y57.0, very good: 57.1Y62.5, and
excellent: Q62.6 for men; poor: e47.4, fair: 47.5Y52.6, good:
52.7Y57.0, very good: 57.1Y62.1, and excellent: Q62.2 for
women; Department of Physical Fitness Website, Ministry
of Education, Taiwan, ROC, 2014c).
Research Process and Statistical Analysis
Ethical approval was obtained from the institutional review
board of Tri-Service General Hospital National Defense Medical
Center (TSGHIRB no. BT101-03). Written informed con-
sent was obtained from all of the participants after the study
had been explained to them. All of the data that were col-
lected were treated confidentially, and all of the participants
were free to withdraw at any time during the study without
affecting their treatment. Outcome measures were obtained
at three time points: pretest, posttest, and follow-up. All
participants maintained their own medication schedule.
Statistical analysis was performed using IBM SPSS Version
20.0. Descriptive statistical analysis was used to examine the
demographic and clinical characteristics of participants. The
inferential statistical analysis consisted of t tests for contin-
uous variables and chi-square tests for categorical variables
to examine the homogeneity between the two groups. A
generalized estimating equation (GEE) model was employed
to account for outcome dependence due to repeated measure-
ments and to evaluate the effects of the intervention on body
composition and physical fitness. Statistical significance was
recognized as p G .05.
Results
Participant Characteristics
This study initially recruited 60 participants. There were
six dropouts during the study period, with four dropping
out from the experimental group and two dropping out
The Journal of Nursing Research Shu-Li Cheng et al.

from the control group, for an attrition rate of 10.0% (6/60).
The reasons for dropping out included vocational rehabili-
tation (n = 4) or hospital discharge (n = 2). Thus, the data
for 26 participants in the experimental group and 28 in the
control group were available for and used in the analysis
work. Table 1 summarizes the demographic characteristics
for each group and their clinical conditions. Most participants
were men, with 20 men and 6 women in the experimental
group and 22 men and 6 women in the control group. Being
unmarried and holding a medium level of education were the
most common characteristics for both groups. Demographic
and clinical characteristics were homogeneous between the
two groups.
Effects on Health-Related Fitness
Table 2 summarized the GEE results of bodyweight, BMI,
1-minute flexed leg sit-up, sit-and-reach test, and 3-minute
step test at pretest, posttest, and follow-up. The GEE model
parameters for health-related fitness used parameter esti-
mates and standard errors for a model with a correlation
matrix and model-based estimates of variance. The model
showed no significant between-group differences in body-
weight (p = .22) at pretest. However, the time effect was
significantly different at both posttest (p G .001) and follow-up
(p G .001) compared with pretest for the control group.
Moreover, trend differences decreased significantly in the
bodyweight for the experimental group between the pretest
and both the posttest versus follow-up time points (p G .001)
because of the interactions between time and group. The
results for BMI were similar to the results for bodyweight.
Regarding muscular endurance, no significant between-
group differences were found (p = .35) at pretest. Signifi-
cantly, the time effect resulted in a statistically significant
difference for muscular endurance between the pretest and
the posttest (p = .01) but not at the pretest and follow-up
(p = .13) for the control group. The trend differences sig-
nificantly increased in muscular endurance for posttest versus
pretest (p G .001) but not for follow-up versus pretest (p = .22)
for the experimental group.
Furthermore, we found no significant between-group
differences in terms of flexibility at pretest (p = .30). No
significant time effect on flexibility was identified for the

TABLE 1.
Demographic and Clinical Characteristics of the Two Groups (N = 54)
Experimental (n = 26) Control (n = 28)
n % Mean SD n % Mean SD 2 2/t p

Gender 2 2 = 0.02 .88

Male 20 76.9 22 78.6
Female 6 23.1 6 21.4
Marital status
Single 22 84.6 19 67.9 2 2 = 2.07 .15
Married 4 15.4 9 32.1
Highest level of education
Junior high or below 5 19.2 8 28.6 2 2 = 0.89 .64
Senior high 11 42.3 12 42.9
College or above 10 38.5 8 28.6
Overweight/obese (BMI Q 24)
No 12 46.2 8 28.6 2 2 = 1.79 .18
Yes 14 53.8 20 71.4
Age (years) 43.7 12.70 47.36 9.68 t = j1.17 .25
Health-related index
Height (cm) 1167.46 8.57 165.79 9.57 t = 0.68 .50
Bodyweight (kg) 67.46 15.37 72.50 15.38 t = j1.20 .23
BMI (kg/m2) 23.95 4.71 26.24 4.21 t = j1.89 .07
Blood pressure (mmHg)
Systolic 108.04 17.81 108.21 18.87 t = j0.04 .97
Diastolic 66.58 10.56 69.36 14.99 t = j0.78 .44
Heart rate (beats/minute) 78.46 12.66 79.86 12.52 t = j0.41 .69
Fitness
Muscular endurance 12.54 8.98 10.21 9.27 t = 0.94 .35
Flexibility 9.81 9.49 13.04 11.83 t = j1.10 .28
Cardiorespiratory endurance 38.88 20.52 35.45 20.84 t = 0.61 .55

Note. BMI = body mass index.

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Aerobic Dance Program for Patients With Schizophrenia VOL. 00, NO. 0, MONTH 2017

TABLE 2.
The Results of Generalized Estimating Equations for Health-Related Fitness (N = 54)
Muscular Cardiorespiratory
Bodyweight BMI Endurance Flexibility Endurance
$ p $ p $ p $ p $ p

Intercept 72.50 G.001 26.24 G.001 10.21 G.001 13.04 G.001 35.45 G.001
a
Exp. group j5.04 .22 j2.29 .05 2.32 .35 j3.23 .30 3.43 .50
Posttestb j0.26 G.001 j0.14 G.001 j2.21 .01 1.86 .07 j9.95 G.001
Follow-upb j0.62 G.001 j0.26 G.001 j1.29 .13 j0.50 .62 j12.87 G.001
Exp. group  Posttestc j0.84 G.001 j0.28 G.001 4.56 G.001 3.57 .02 11.77 .01
c
Exp group  Follow-up j0.28 G.001 j0.06 G.001 1.48 .22 4.65 G.001 16.57 G.001

Note. Exp. group = experimental group; BMI = body mass index.

a
Reference group: control group. bReference group: pretest. cReference group: Control group  Pretest.

control group at either the posttest (p = .07) or follow-up
(p = .62) time points, whereas the trend differences sig-
nificantly increased at both the posttest (p = .02; posttest vs.
pretest) and follow-up (p G .001; follow-up vs. pretest) time
points for the experimental group.
Finally, we found no significant between-group differences
in terms of cardiorespiratory endurance at pretest (p = .50).
For the control group, the time effect showed significant dif-
ferences between the pretest and both posttest (p G .001) and
follow-up (p G .001). For the experimental group, we iden-
tified significantly increased trend differences between the pre-
test and both the posttest (p = .01) and follow-up (p G .001).
Discussion
This study supports the efficacy of using an 8-week aerobic
dance program to enhance health-related fitness, to signifi-
cantly reduce the risk of chronic disease, and to slow or halt
the rate of decline in physical functions. The baseline value
for all of the participants averaged 70.07 kg for bodyweight
and 25.14 kg/m2 for BMI, which is classified as overweight,
with 63% of the participants classified as either overweight
or obese. The 8-week aerobic dance program decreased
BMI at both the posttest and follow-up time points. This is
in accord with one study that found reduced bodyweight
and BMI in patients with schizophrenia or a schizoaffective
disorder after a 12-week weight control program (Vreeland
et al., 2003) as well as with one systematic review that con-
cluded that a short-term walking period contributed to small
reductions in BMI (Soundy et al., 2014).
At the beginning of this study, the average values for
muscular endurance, flexibility, and cardiorespiratory en-
durance of participants were below the normative values for
the general, healthy population. After the 8-week aerobic
exercise program, these three values were all significantly
higher. This finding echoes the findings of other studies (Beebe
et al., 2005; Cheng et al., 2010; Fogarty et al., 2004;
Heggelund et al., 2011; Shahana, Nair, & Hasrani, 2010).
Fogarty et al. (2004) found that, after a 3-month exercise
training, patients with schizophrenia increased their phys-
ical strength, endurance, and fexibility. Moreover, Cheng
et al. (2010) found that moderate-intensity aerobic exercise
programs, especially aerobic dance, improved muscular en-
durance and flexibility signifcantly. Prior studies have also
found that patients with schizophrenia who practiced moderate-
intensity aerobic exercise are better able to endure whole-
body muscle movements and thus to increase muscular tone
and fexibility as well as cardiorespiratory endurance. Beebe
et al. (2005) found that a 16-week walking program for
outpatients with schizophrenia resulted in reduced body fat
and BMI values and better aerobic fitness. Heggelund et al.
(2011) showed that 8 weeks of high-intensity aerobic exercise
increased cardiopulmonary function in people with schizo-
phrenia. However, these studies were conducted in a diverse
range of environments: in the community (Beebe et al.,
2005; Heggelund et al., 2011; McDevitt, Wilbur, Kogan, &
Briller, 2005), in hospitals (Cheng et al., 2010), and in
psychiatric rehabilitation centers (McDevitt et al., 2005).
Furthermore, the interventions that were used in these studies
varied significantly from one another, including an exercise
program that was combined with individual counseling
(McDevitt et al., 2005) and physical exercise programs of
3Y16 weeks in duration and of 2Y5 days per week (Beebe
et al., 2005; Cheng et al., 2010; Fogarty et al., 2004; Helgerud
et al., 2011; McDevitt et al., 2005; Vreeland et al., 2003).
Exercise training helps patients with schizophrenia in-
crease muscular endurance, flexibility, and cardiorespiratory
endurance. Therefore, physical exercise may improve health-
related fitness (Cheng et al., 2010; Heggelund et al., 2011).
The participants in this study were all motivated to par-
ticipate in the exercise program. Motivation may play an
important role in fulfilling a successful exercise program.
This study developed a structured aerobic dance routine,
which follows principles that address the abilities and
strengths of participants to promote a return to both a
‘‘normal’’ life (Fogarty et al., 2004) and a ‘‘more meaningful

Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
The Journal of Nursing Research
life’’ (Cullen & McCann, 2015) through the attainment of
success. Therefore, healthcare professionals may consider
providing patients with schizophrenia with an aerobic dance
program to encourage improved health-related fitness. Hav-
ing a supportive and noncompetitive environment while doing
exercise and establishing a good social network during the
exercise process are crucially important for patients with
schizophrenia (Carless & Douglas, 2008).
Limitations
This study is affected by several limitations. First, we took
no measures to prevent against the Hawthorne effect.
Thus, future researchers should employ a double-blind study
design. Second, the generalization of these results to patients
with other psychiatric disorders must be done with caution,
as all of the participants had been given a diagnosis of
schizophrenia only.
Conclusions
Aerobic dance is a rhythmic physical exercise that combines
the health benefits of vigorous exercise with the fun of dancing.
The emphasis of aerobic dance on fitness and the consump-
tion of energy without the requirement of prior practice or
skills is beneficial for patients experiencing a serious mental
illness. This study supports that the 8-week aerobic dance
program leads to weight loss and the improvement of BMI,
muscular endurance, flexibility, and cardiorespiratory en-
durance in patients with schizophrenia. In addition, the im-
provements in flexibility and cardiorespiratory endurance
persisted for at least 4 weeks after the exercise program had
ended. Therefore, the aerobic exercise program improved
the physical fitness of the participants. Health-related fitness
promotion among patients with schizophrenia is necessary
and crucial. Thus, the findings of this study support the
benefits of aerobic dance exercises in terms of enhancing the
physiological functions of patients with schizophrenia.
However, an 8-week aerobic dance intervention is relatively
short in comparison with the interventions that have been
used in other studies. Thus, we recommend extending the
duration of the intervention in the future. More studies are
needed on topics related to intensity, frequency, duration,
and mode of exercise as well as evidence-based studies that
use a randomized controlled design with blinding and larger
sample sizes. Furthermore, this intervention may contribute
positively to good nursing practice by preventing diseases
and advancing patient rehabilitation, which are useful,
nonpharmacological interventions that may be implemented
by nurses. These may potentially be integrated and form an
active role in therapeutic approaches.
Acknowledgments
This work was funded by the Taiwan Nurses Association.
We also thank Tri-Service General Hospital, Beitou Branch
for their support.
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
Shu-Li Cheng et al.
References
Beebe, L. H., Tian, L., Morris, N., Goodwin, A., Allen, S. S., &
Kuldau, J. (2005). Effects of exercise on mental and physical
health parameters of persons with schizophrenia. Issues in Mental
Health Nursing, 26(6), 661Y676. doi:10.1080/01612840590959551
Brown, S., Inskip, H., & Barraclough, B. (2000). Causes of the
excess mortality of schizophrenia. The British Journal of
Psychiatry, 177, 212Y217. doi:10.1192/bjp.177.3.212
Cheng, S. L., Yeh, M. L., Chung, Y. C., & Huang, K. C. (2010).
Effects of brief aerobic dance or kickboxing on psychiatric
symptoms and physical fitness for patients with schizophrenia.
Taiwanese Journal of Psychiatry, 24(4), 269Y279.
Carless, D., & Douglas, K. (2008). Social support for and through
exercise and sport in a sample of men with serious mental
illness. Issues in Mental Health Nursing, 29(11), 1179Y1199.
doi:10.1080/01612840802370640
Cullen, C., & McCann, E. (2015). Exploring the role of physical
activity for people diagnosed with serious mental illness in
Ireland. Journal of Psychiatric and Mental Health Nursing,
22(1), 58Y64. doi:10.1111/jpm.12179
Daley, A. J. (2002). Exercise therapy and mental health in clinical
populations: is exercise therapy a worthwhile intervention?
Advanced in Psychiatric Treatments, 8(4), 262Y270. doi:10.1192/
apt.8.4.262
Department of Physical Fitness Website, Ministry of Education,
Taiwan ROC. (2014a). Fitness norms sit-ups 60 seconds.
Retrieved from http://www.fitness.org.tw/model04.php
Department of Physical Fitness Website, Ministry of Education,
Taiwan ROC. (2014b). Sitting forward bending body. Retrieved
from http://www.fitness.org.tw/measure02.php
Department of Physical Fitness Website, Taiwan Ministry of
Education, ROC. (2014c). Fitness norms sit and reach. Re-
trieved from http://www.fitness.org.tw/model05.php
Faulkner, G., Cohn, T., & Remington, G. (2006). Validation of a
physical activity assessment tool for individuals with schizo-
phrenia. Schizophrenia Research, 82(2Y3), 225Y231. doi:10.1016/
j.schres.2005.10.020
Fogarty, M., Happell, B., & Pinikahana, J. (2004). The benefits of
an exercise program for people with schizophrenia: A pilot
study. Psychiatric Rehabilitation Journal, 28(2), 173Y176.
Gorczynski, P., & Faulkner, G. (2010). Exercise therapy for
schizophrenia. The Cochrane Database of Systematic Reviews,
(5), CD004412. doi:10.1002/14651858 .CD004412.pub2
Harvey, P. D., Green, M. F., Keefe, R. S., & Velligan, D. I. (2004).
Cognitive functioning in schizophrenia: A consensus state-
ment on its role in the definition and evaluation of effective
treatments for the illness. The Journal of Clinical Psychiatry,
65(3), 361Y372.
Heggelund, J., Nilsberg, G. E., Hoff, J., Morken, G., & Helgerud, J.
(2011). Effects of high aerobic intensity training in patients with
schizophreniaVA controlled trial. Nordic Journal of Psychiatry,
65(4), 269Y275. doi:10.3109/08039488.2011.560278
Hennekens, C. H., Hennekens, A. R., Hollar, D., & Casey, D. E.
(2005). Schizophrenia and increased risks of cardiovascular
disease. American Heart Journal, 150(6), 1115Y1121. doi:10.1016/
j.ahj.2005.02.007
Johnstone, R., Nicol, K., Donaghy, M., & Lawrie, S. (2009).
Barriers to uptake of physical activity in community-based
Aerobic Dance Program for Patients With Schizophrenia
patients with schizophrenia. Journal of Mental Health, 18(6),
523Y532. doi:10.3109/09638230903111114
McDevitt, J., Wilbur, J., Kogan, J., & Briller, J. (2005). A walking
program for outpatients in psychiatric rehabilitation: Pilot study.
Biological Research for Nursing, 7(2), 87Y97. doi:10.1177/
1099800405278116
McLeod, H. J., Jaques, S., & Deane, F. P. (2009). Base rates of
physical activity in Australians with schizophrenia. Psychiatric
Rehabilitation Journal, 32(4), 269Y275. doi:10.2975/32.4.2009
.269.275
Ozbulut, O., Genc, A., Bagcioglu, E., Coskun, K. S., Acar, T.,
Alkoc, O. A., I Ucok, K. (2013). Evaluation of physical
fitness parameters in patients with schizophrenia. Psychiatry
Research, 210(3), 806Y811. doi:10.1016/j.psychres.2013.09.015
Pelham, T. W., & Campagna, P. D. (1991). Benefits of exercise
in psychiatric rehabilitation of persons with schizophrenia.
Canadian Journal of Rehabilitation, 4, 159Y168.
Saha, S., Chant, D., & McGrath, J. (2007). A systematic review
of mortality in schizophrenia: Is the differential mortality
gap worsening over time? Archives of General Psychiatry,
64(10), 1123Y1131. doi:10.1001/archpsyc.64.10.1123
Scheewe, T. W., Takken, T., Kahn, R. S., Cahn, W., & Backx, F. J.
(2012). Effects of exercise therapy on cardiorespiratory
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 00, NO. 0, MONTH 2017
fitness in patients with schizophrenia. Medicine and Science
in Sports and Exercise, 44(10), 1834Y1842. doi:10.1249/MSS
.0b013e318258e120
Shahana, A., Nair, U. S., & Hasrani, S. S. (2010). Effect of
aerobic exercise programme on health related physical fitness
components of middle aged women. British Journal of Sports
Medicine, 44, i19Yi19. doi:10.1136/bjsm.2010.078725.60
Soundy, A., Muhamed, A., Stubbs, B., Probst, M., &
Vancampfort, D. (2014). The benefits of walking for individ-
uals with schizophrenia spectrum disorders: A systematic
review. International Journal of Therapy and Rehabilitation,
21(9), 410Y420. doi:10.12968/ijtr.2014.21.9.410.
Thompson, W. R., Gordon, N. F., & Pescatello, L. S. (2013).
ACSM’s guidelines for exercise testing and prescription.
Washington, DC: Lippincott Williams & Wilkins.
Vreeland, B., Minsky, S., Menza, M., Rigassio Radler, D.,
Roemheld-Hamm, B., & Stern, R. (2003). A program for
managing weight gain associated with atypical antipsychotics.
Psychiatric Services, 54(8), 1155Y1157. doi:10.1176/appi.ps.54.8
.1155
World Health Organization. (2009). Global health risks: Mortality
and burden of disease attributable to selected major risks.
Geneva, Switzerland: Author.