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BAB I

PENDAHULUAN

1.1 Latar Belakang

Skizofrenia merupakan gangguan mental berupa munculnya gangguan pikiran, emosi,


persepsi, gerakan, serta perilaku aneh. Skizofrenia merupakan suatu gangguan jiwa yang berat
yang ditandai dengan penurunan atau ketidakmampuan berkomunikasi, gangguan realitas
(halusinasi atau waham), afek tidak wajar atau tumpul, gangguan kognitif ( tidak mampu
berfikir abstrak) serta mengalami kesukaran melakukan aktivitas sehari hari ( Keliat, 2011).
Skizofrenia merupakan sindrom dengan berbagai presentasi dan suatu variabel, perjalanan
penyakit umumnya jangka panjang, serta sering kambuh.

Skizofrenia merupakan gangguan yang bersifat kronis dan dapat kambuh sehingga dalam
merawat pasien dapat menimbulkan beban dalam diri caregiver. Beban yang dirasakan oleh
caregiver akan mengakibatkan konsekuensi negatif terhadap keadaan fisik, emosi, serta
ekonomi mereka. Tanda dan gejala skizofrenia menurut Keliat (2011) diantaranya gejala positif
(waham, halusinasi, perubahan arus pikir dan perubahan perilaku) sedangkan gejala negatif
dari skizofrenia (apatis, Blocking, pembicaraan berhenti tiba tiba, isolasi sosial). Perubahan
perilaku sendiri itu meliputi amuk, marah dan menyebabkan perilaku kekerasan.

Prevelensi penderita skizofrenia di Indonesia yakni 0,3 1% dan muncul pada usia 15
35 tahun. Penderita skizofrenia tidak mampu menjalankan aktivitas sehari hari dengan normal
sehingga membutuhkan caregiver informal seperti orang tua, teman, atau kerabat. Prevelensi
seumur hidup hampir mencapai 1%, insides setiap tahunnya sekitar 10 15 per 100.000, dan
perawatan rata rata di dokter umum adalah 10 -20 pasien skizofrenia, bergantung pada lokasi
dan lingkungan sosial tempat praktik (Davies&Craig, 2009).

Terapi dalam mengatasi gangguan jiwa yang telah banyak dikembangkan adalah terapi
senam (Astuti 2014, dalam Daley 2002). Salah satu manfaat dari senam aerobik adalah untuk
melawan depresi, dan jika kegiatan tersebut dilakukan secara teratur dapat meningkatkan mood
seseorang. Kegiatan tersebut tidak hanya meningkatkan denyut jantung dan memperbaiki
mood seseorang saja, tetapi aerobik juga dapat membuat seseorang merasa senang dan menjadi
ramah (Astuti 2014, dalam Nelly 2009).

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Faulkner dan Sparkes (1999) dalam Astuti, 2014) melakukan sebuah uji tentang
pengaruh senam aerobik sebagai terapi bagi pasien skizofrenia, dan didapatkan hasil bahwa
dalam rentang waktu 10 minggu dapat membantu mengurangi gangguan pada pasien
skizofrenia (halusinasi dengar dan meningkatkan pola tidur yang lebih baik) (Astuti 20014
dalam Daley,2002). Menurut Campbell & Foxcroft (2008) dalam Astuti 2014, beberapa
penelitian tentang aktivitas fisik dan terapi olahraga terhadap gangguan kejiwaan,
membuktikan bahwa aktifitas fisik dapat meningkatkan kepercayaan pasien terhadap orang
lain, sehingga pasien bisa lebih membuka diri untuk dapat bersosialisasi dengan baik.

1.2 Tujuan Penulisan

Memaparkan informasi terkini dengan evidence based di area keperawatan dan


meningkatkan critical thingking tentang manfaat hasil penelitian terkait topic The Effect of
Regular Aerobic Exercise On Both Positive and Negative Symptoms of Male Patients With
Chronic Schizophrenia.

2
BAB II

JURNAL PENELITIAN

Available online at www.ijmrhs.com

International Journal of Medical Research &


ISSN No: 2319-5886 Health Sciences, 2016, 5, 11:529-535

The effect of regular aerobic exercise on both positive and negative symptoms
of male patients with chronic Schizophrenia: A double blinded study

Hossein Namdar areshtanab1, Hossein Ebrahimi2, Ali Reza Farnam3, Asghar


Mohammadpoorasl4, Bahram Jamali5 and Shahram Piri6*

1
Assistant Professor of Nursing Education, Ph.D in nursing , Nursing & Midwifery
Faculty,Tabriz University of Medical Sciences.
2
Associate Professor of Nursing Education, Ph.D in nursing , Nursing & Midwifery Faculty ,
Tabriz University of Medical Sciences.
3
Professor of Psychiatry, Faculty of Medicine , Tabriz University of Medical Sciences.
4
Assistant Professor of Epidemiology , Department of Epidemiology and Biostatistics, School
of Health, Tabriz University of Medical Sciences,
5
Ph.D in Cardiovascular exercise physiology, Department of Exercise and Sports
Sciences, Tabriz University of Medical Sciences.
5
Masc.student in Psychiatric Nursing , Student' Research Committee, Nursing & Midwifery
Faculty , Tabriz University of Medical Sciences''
*Corresponding Email: pirishahram67@yahoo.com

__________________________________________________________________________________

ABSTRACT

Nowadays in different communities, sport is being used as a mean to prevent diseases, improve health
and have a sense of well-being. The evidences show that sport improves mental health, self-confidence,
cognitive performance and on the other hand it decreases anxiety and depression. Therefore, this study
aims to investigate the effect of regular aerobic exercise on both positive and negative symptoms of
male patients with chronic Schizophrenia who are hospitalized at RAZI Psychiatric hospital, TABRIZ,
IRAN. The present study, which has been done on 68 male patients with chronic Schizophrenia, is a
double-blinded clinical trial study. Randomly chosen samples have been categorized in two groups of
case(34 patients) and control (34 patients). The case group samples participated in the designed
exercise program during 24sessions over 8 weeks, 11hours in total. The positive and negative
symptoms for both groups were assessed in two steps before starting the exercise program and also
after that through Standard Anderson Positive and Negative questionnaire (SAPS.SANS). The data of
both groups were compared using statistical tests, T-test, paired t-test , and Chi-square test. The results

3
demonstrated that there is no significant relationship between before intervention in terms of positive
and negative symptoms of disease (P>0.05). Furthermore, the results indicated that there is a
significant statistical difference between the average total score of positive and negative symptoms of
the disease in both case and control group after intervention (P<0.05).Health system officials and
managers can implement programs and solutions for creating regular aerobic exercises for patients
with Schizophrenia in order to reduce disease symptoms and improve the rate of recovery in patients
with chronic mental disorders.

Key words: Schizophrenia, Regular Aerobic Exercise, Positive and Negative Symptoms

__________________________________________________________________________________
INTRODUCTION

Schizophrenia is a complex mental disorder that makes the most profound and devastating impact on
the persons life. In addition, it has been considered as one of the most important and debilitating
mental disorder which has a special place in all communities of psychiatry and psychology worldwide
[1]. The prevalence of Schizophrenia is between 0.8 and 1 % and its mortality rate is 15 per 100,000
people [2]. Due to the chronic course of the disease, it is often accompanied with the phenomenon of
hospitalization, inadequate treatment, relapse, and re-hospitalization. According to the statistics, the
number of schizophrenic patients needing serious health and rehabilitation services, and
hospitalization in Iran are over 600,000 people [3].

Schizophrenia is often described in terms of positive and negative symptoms [4]. Positive symptoms
are those that most individuals do not normally experience, but are present in people with
schizophrenia. These symptoms include delusions, disordered thinking and speech, tactile, auditory,
visual, olfactory and gustatory hallucinations can be observed only in patients with schizophrenia.
However, the negative symptoms are deficits of normal emotional responses or other thought process
such as psychomotor retardation [6]. Negative symptoms are less responsive to medication than
positive symptoms. Based on study results, 30% of the schizophrenic patients didnt respond to the
treatments, and they were refractory to treatment [7]. Moreover, the studies demonstrate that the
negative symptoms have the most negative impact on quality of life, functional disabilities, and the
burden of caring on others than do positive symptoms [8]. The medications for treating schizophrenia
can cause side effects such as sleep disorder, weight gain, dry mouth, extrapyramidal side effects,
neuroleptic malignant syndrome, numbness and muscle stiffness [9-11]. Although medications might
improve symptoms in patients with schizophrenia, these patients are still suffering from their poor
social performance [12]. Studies have shown that, though the prevalence of disease is almost equal
in both sexes, the prognosis of disease were more severe due to the lower age of onset of the disease.
On the other hand, these patients especially, men smoke more than healthy people, and they are
sometimes physically inactive or sedentary [14].

According to the evidences, a combination of psychopharmacologic treatments psychopharmacology


interventions such as psychotherapy, family therapy and occupational therapy is the treatment
strategy for patients with schizophrenia. Nowadays, the prompt diagnosis and treatment of disease
by different pharmacological and nonpharmacological interactions can make a significant

4
improvement in this disease. One of these non-pharmacological treatments is sport activities which
improves mood and emotional drain.

Nowadays, in different communities, sport is being used as a method to prevent diseases, improve
health and have a sense of well-being. The evidences demonstrate that exercise can improve mental
health, self-confidence, and cognitive performance and decrease anxiety, depression, and negative
mood in patients with schizophrenia[16]. Due to the positive mental and physical effects of exercise,
it plays a vital role in rehabilitation and treatment of psychotic patients [17,18]. There are two types
or modes of exercise: aerobics and anaerobics. Aerobic exercises can increase peak oxygen
consumption in these patients. Aerobic exercise is an activity which increases the pulse rate and burns
calories. Running, swimming, cycling, boating, walking are examples of aerobic exercises [19]. Beebe
et al [2005] demonstrated that aerobic exercises in a long-term can improve fitness, body mass index
[BMI], more vitality and mobility in psychopaths. In addition, they are encouraged to communicate
with others and participate in social activities [20]. Overall, the results of many studies has well
demonstarted the positive effects of regular aerobic exercises on alleviating symptoms of mental
disorders such as stress, anxiety, depression, increasing selfconfidence, and improving mood state
[21,22]. However, there havent been many studies conducted on the effects of aerobic exercise on
positive and negative symptoms of schizophrenia so the effect of aerobic exercise on these symptoms
is not clear.

On the other hand, the results of studies have indicated that nurses have an active role in prevention
of disorders, treatment and rehabilitation of patients. In this regard, the nurses have a crucial role in
encouraging psychiatric patients to exercise. In addition, the exercise program is an effective, cheap,
accessible, and implementable method [23]. Nurses are the key members of health care and
rehabilitation teams and have a significant role in reception, treatment preparation, supportive
physical, mental and social cares of patients. Moreover, nurses are responsible for providing a specific
care plan to facilitate rehabilitation in order to put the patient in a state of optimal health and prevent
the possible side-effects of disease. Thus nurse plays the role of caregiver, consultant, and supporter
in rehabilitation team. In addition, the nurse is responsible for guiding and supporting the all
rehabilitation programs [24].

Considering the important role of nurses in rehabilitating the patients with mental disorders and the
role of exercise in rehabilitating the schizophrenic patients, and also due to lack of studies in this field
in Iran, this study aims to investigate the effect of regular aerobic exercise on positive and negative
symptoms in schizophrenic patients hospitalized in Razi psychiatric hospital, Tabriz.

MATERIAL AND METHODS

This study is a clinical trial that is done as pre- and post- test and a control group on 68 patients with
chronic schizophrenia hospitalized in Razi Psychiatric Center, Tabriz. Using a randomized block
sampling, the patients were allocated into two intervention and control groups. Following ethical
approval from Ethics Committee of Tabriz University of Medical Sciences receiving the code
IRCT2016020823525N3 from Clinical Trial Registry, this study carried out within 16 month in 1394-95.

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The inclusion criteria for this study includes the confirmed diagnosis of chronic schizophrenia by
psychiatrist, full physical health to engage in regular aerobic exercise through physical examination by
a physician, investigation of previous history of physical illness, the ability to cooperate and answer
the questions, the absence of any problem on foot such as wound or scar, and finally patients who
were not eligible for inclusion were excluded. At the beginning of the research, both case and control
groups were matched based on the variables of age, marital status, and education level. Introducing
himself and describing the purpose of the study to patient, the researcher completes the standard
positive and negative symptoms questionnaire for both case and control groups through guided
interview and based on the clients dialogues.

At first, Standard Anderson Positive and Negative Scale were exploited to assess the positive and
negative symptoms of Schizophrenia. The answer choices in questionnaire were graded as 0-not
present, 1- Visible, 2- Mild, 3- moderate, 4-moderelatly severe, 5-severe (25). Then, the samples were
randomly divided into two intervention and control groups. The sample size per group is 34 subjects
which was determined by Cronbachs alpha of 0.5 and power of 80%. The similar study by Mehrdad
KalateJari et al in Shahroud was exploited for this purpose too (26). The purposes of the study and its
benefits, the confidentiality of information, and the right for withdrawing from the study were
explained to the patients before the start of sampling, and the informed consent form was signed by
them. Data collection was done at the beginning of study and at the end of intervention. The exercise
processes were as the exercise program including three times a week for 8 weeks, and each time one
session for 5min warm up with different types of running, stretching . Then, running at 65% heart rate
reserve for 12 minutes was conducted in the first week that it was raised to 26mins and 80% heart
rate reserve in 8th week ( 2mins were added for exercise time every week, and 5% for the exercise
severity every two weeks). The patients in both groups were advised to refrain from participating in
the other sport activities during the eight-week exercise program. At the end of sessions, the positive
and negative symptoms questionnaire was completed again for the subjects of both case and control
groups. Thus, the data were collected and classified. Finally, the data were encoded and analyzed by
SPSS software Version 13 and descriptive and inferential statistical tests (T-test, paired-t test, and Chi-
Square test)

Research Findings:
Based on the research findings, the mean age participants is 14.7+37.82years and all of them are men.
Participants levels of education were primary and most of them were single. Table 1 demonstrates
the participants demographic information. Chi-square test and T-test didnt show a significant
statistical difference between demographic information of both groups (p>0.05) and both control and
test groups were matched in terms of demographic information (Table 1). The mean total score of
positive and negative symptoms of both groups before intervention were compared by independent
t-test, and no significant statistical difference was observed. (p>0.05) table (2).

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Table 1. Comparing socio-demographic information of patients participating in both groups

p-value Control Case Group Variables Level Variables


Chi-Square Test Group n=34 n=34
21(61/8) 25(73/5) Single
0/42p= 8(23/5) 7(20/6) Married Marital Status
5(14/7) 2(5/9) Divorced
10(29/4) 13(38/2) Primary
7(20/6) 6(17/6) Secondary
Patients
10(29/4) 12(35/3) High School
0/35p= Education
0(0) 1(2/9) Higher
level
Education
7(20/6) 2(5/9) illiterate
p-value
Independent T-
Test
p =0/54 38/356/64 37/297/68 - Age

Statistical tests indicated that there is no significant difference between samples of both control and
intervention groups.

There was significant statistical difference between mean scores of positive and negative symptoms
in both case and control group after intervention (p<0.05). Finally, there was significant statistical
difference between the mean positive and negative symptoms before and after intervention in case
group (p<0.05) tables (2) and (3).

Table 2: Comparing the mean total score of positive and negative symptoms before or after intervention in the study groups

Control Case Group


Group
After Before After Before
p-value Variables of Study
p-value Intervention Intervention Intervention Intervention
Paired
Paired T-test SD The SD The SD The SD The
Ttest
Mean Mean Mean Mean
P=0/08 62/384 66/087/03 P=0/01 59/614/69 65/614/73 Positive Symptoms
P=0/15 43/972/92 44/735/22 P=0/001 38/264/12 42/023/51 Negative Symptoms

Table 3: Comparing the mean total score of positive and negative symptoms before or after intervention in the study groups

After Intervention Before Intervention


p-value Case Control p-value Case Control
Variables of
Independent T- Group Group Independent T- Group Group
Study
test SD The SD The test SD The SD The
Mean Mean Mean Mean
P=0/01 59/614/69 62/384 P=0/11 65/614/73 66/087/03 Positive Symptoms
P=0/001 38/264/12 43/972/92 P=0/17 42/023/51 44/735/22 Negative
Symptoms

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CONCLUSION AND DISCUSSION

This study aims to investigate the effect of regular aerobic exercise on positive and negative symptoms
of male patients with chronic schizophrenia. The results of the study indicated that the effect of
aerobic exercises on positive and negative symptoms of schizophrenic patients is statistically
significant. The results of several studies in this field indicate the approval of this subject matter
[16,17,23,27]. In a study, Acil et al[2008] performed an aerobic exercise program for 10 weeks on 30
inpatient and outpatients with schizophrenia. The result indicated that aerobic exercise made a
significant decrease in the positive symptoms of intervention group [23] which is consistent with the
results of our study. The study by Falkai et al[2013] indicated that the regular aerobic exercise cause
an increase in brain gray matter volume of patients with chronic schizophrenia and improve their
symptoms [16]. Moreover, the case study of Faulkner in 2006 indicated that exercise programs are
considered as adjunctive therapies for schizophrenic patientsand helped improve attitudes of
schizophrenic patients toward their illusions [18] which is in linewith the results of this study.

The results of study by Fogarty [2005] indicated that the participation of patients with schizophrenia
in exercise programs had a beneficial result in improving physical health, providing energy and
compatibility for schizophrenic patients. In addition, it can increase physical activity, a sense of
cooperation, and develop social skills and cognitive function in them [28] which is consistent with the
result of our study. Furthermore, the results of research indicate that the exercise has the capability
to put an effect on mental and physical health simultaneously [29]. Almost all studies in this field
emphasize that the regular exercise program have a beneficial result on mental and physical health of
individuals [29-31] which is in line with the approval our research results..

Furthermore, the evidences indicate that exercise improves mental health, reduce anxiety,
depression, negative mood, and also improve self-confidence and cognitive function in schizophrenic
patients. In addition, it has an important role in rehabilitation and management of psychiatric patients
treatment due to its positive mental and physical effects which is in line with the result of our study
[32-33]. In a study, Pelham et al [1991] investigated the physiologic, psychological and social effects
of exercise on schizophrenic patients and found that a regular exercise program can reduce depression
and increase the sense of well-being in patients [27] which is consistent with the results of this study.
The results of study by Beebe et al [2006] demonstrated that the schizophrenic patients had less
psychiatric symptoms than control group at the end of regular exercise program. Furthermore, the
participants of intervention group had lower body mass index than the control group at the end of
program [29] which is consistent with the results of this study.

Review of the related litrature revealed that there is nodiferent study with the same resluts of this
study. In addition, the results of most studies refered to this point that exercise is exploited as an
effective method to prevent diseases, improve health and have a sence of well-being in different
communites. Moreover, the evidences inidcate that exercise improves mental health, self-confidense,
cognitive function and reduce anxiety, depression and negative mood in schizophrenic patients, and
it has an important role in rehabiltating and managing psychiatric patients treatment due to its
positive mental and physical effects [16] which is in linewith the results of our study. Since the use of

8
drug therapy and behavioral therapy are expensive and have a short period of
effectiveness.Therefore, it seems necessary to deploy low-cost and simple solutions in rehabilition
programs for schizophrenic patients. So it is conlcuded from the obtained results that exercise has a
crucial role in mental health and individual health of patients with chronic schizophrenia.
Furthermore, many studies have indicated the positive effects of regular aerobic exercises on
reducing the symptoms related to the mental disorders such as stress, anxiety, depression and
improving self-confidense and mood. The research results demonstrate that many patients with
schizophrenia have sedantary lifestyle [29]. So, simultaneous with increasing the mobility in them, the
symptoms imrovement can be accelerated by the results of this study. Moreover, by the results of this
study, health systems officials and administrators can implement programs to increase the regular
aerobic exercise for patients with mental disorders especially schizophrenia in order to improve
improve the rate of recovery in patients with chronic mental disorders. Furthermore,this can be
exploited to improve the symptoms of schizophrenic patients in society by educating the patients
family.

The Limitations of the Study


Like the other researches, this study has got limitations such as: socio-psychological status of patients
during the interview and questionnaire and also exercises which could affect how they response and
function. Moreover, this study has been conducted in only one province which cannot be generalized
to the other regions in our country. This study has been merely conducted on male patients due to
the low number of women with chronic schizophrenia and their unwillingness to participate in aerobic
exercises. Thus, the results of this study cannot be generalized to all schizophrenic patients. So due to
the limitations of this study, it is suggested to conduct a similar research on women. In addition, the
intervention should be repeated by increasing the number of exercise sessions. Since this study is a
clinical trial, and the effect of confounding variables in the study is inevitable, it was tried to control
partially the confounding variables through choosing the control group and assigning participants
randomly into two groups.

Acknowledgment
This study is part of masters thesis which was approved by Tabriz University of Medical Sciences. The
researchers hereby express their gratitude to the Deputy of Research and Technology for financial
support, Razi Medical Centers staff for their sincere cooperation, and all schizophrenic patients
hospitalized in these centers for their active participation in this study.

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BAB III

PEMBAHASAN

3.1 Profil Penelitian


Judul Penelitian
The Effect of Regular Aerobic Exercise On Both Positive and Negative Symptoms
of Male Patients With Chronic Schizoprenia : A double Blinded Study
Pengarang/Author
1. Hossein Namdar Areshtanab
2. Hossein Ebrahimi
3. Ali Reza Farnam
4. Asghar Mohammadpoorasl
5. Bahram Jamali
6. Shahram Piri
Sumber Jurnal/Source
International Journal of Medical Research and Health Sciences
Major/Minorr subject (Key Words)

Schizophrenia, Regular Aerobic Exercise, Positive and Negative Symptoms.

Abstract
Nowadays in different communities, sport is being used as a mean to prevent
diseases, improve health and have a sense of well-being. The evidences show that
sport improves mental health, self-confidence, cognitive performance and on the
other hand it decreases anxiety and depression. Therefore, this study aims to
investigate the effect of regular aerobic exercise on both positive and negative
symptoms of male patients with chronic Schizophrenia who are hospitalized at
RAZI Psychiatric hospital, TABRIZ, IRAN. The present study, which has been
done on 68 male patients with chronic Schizophrenia, is a double-blinded clinical
trial study. Randomly chosen samples have been categorized in two groups of
case(34 patients) and control (34 patients). The case group samples participated in
the designed exercise program during 24sessions over 8 weeks, 11hours in total.
The positive and negative symptoms for both groups were assessed in two steps

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before starting the exercise program and also after that through Standard Anderson
Positive and Negative questionnaire (SAPS.SANS). The data of both groups were
compared using statistical tests, T-test, paired t-test , and Chi-square test. The
results demonstrated that there is no significant relationship between before
intervention in terms of positive and negative symptoms of disease (P>0.05).
Furthermore, the results indicated that there is a significant statistical difference
between the average total score of positive and negative symptoms of the disease
in both case and control group after intervention (P<0.05).Health system officials
and managers can implement programs and solutions for creating regular aerobic
exercises for patients with Schizophrenia in order to reduce disease symptoms and
improve the rate of recovery in patients with chronic mental disorders.
Tanggal Publikasi
Publised Online : 2016

3.2 Deskripsikan Penelitian Berdasarkan Metode PICO

Tujuan Penelitian
Untuk mempelajari efek olahraga aerobic terhadap pasien laki laki dengan
skiizofrenia kronis yang di rawat di Rumah Sakit RAZI Psikiater, TABRIZ <
IRAN.
Desain Penelitian
Using a Randomized Block Sampling
Populasi/Sampel
Populasi 68 laki laki dengan skizofrenia kronis, dibagi menjadi 2
kelompok yaitu kelompok kasus 34 pasien dan kelompok kontrol 34
pasien.
Kriteria inklusi pada penelitian adalah seluruh kesehatan fisik yang
terlihat dalam pelatihan fisik sebelumnya, kemampuan untuk
bekerjasama dalam menjawab pertanyaan, ketidak hadiran yang
disebabkan oleh beberapa masalah pada kaki seperti bekas luka dan
terakhir pasien tidak berhak menyertakan inklusi pengecualian.
Intervention
Proses pelatihan merupakan program pelatihan yang meliputi tiga waktu selama
8 minggu, dan per waktu terdapat 1 sesi selama 5 menit pemanasan dengan tipe

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tipe yang berbeda yaitu berjalan dan peregangan. Kemudian, 65% detak
jantung selama 12 menit dilakukan pada minggu pertama, kemudian dinaikkan
menjadi 26 menit dan 80% detak jantung selama 12 menit dilakukan di minggu
ke 8 (2 menit tambahan untuk waktu latihan per minggu, dan 5% untuk latihan
berat setiap dua minggu). Penderita pada kedua kelompok tersebut disarankan
untuk menahan diri dari aktivitas olahraga yang lainnya selama 8 minggu
program pelatihan. Di sesi terakhir, quesioner gejala positif dan negatif sudah
selesai untuk subjek kedua kasus dan kelompok kontrol.
Comparation
Perbandingan total skor rata rata dari gejala skor positif dan negatif antara
kelompok kasus dan kelompok kontrol.
Outcome
Tabel 1 : Berdasarkan hasil penelitian, rata-rata umur peserta 14.7 + 37. 82
tahun dan semua peserta adalah laki-laki. Level pendidikan peserta yaitu
pemula dan hampir semuanya masih sendiri. Tabel 1 mendemonstrasikan
informasi demografi peserta. Untuk Chi- Square test dan T-test tidak
menunjukkan perbedaan statistik yang signifikan diantara informasi
demografi dari kedua kelompok (p>0.05). kedua kelompok kontrol dan
kelompok kasus yang cocok dalam istilah informasi demografi. Total skor
rata-rata dari gejala postif dan gejala negatif dari kedua kelompok sebelum
gangguan dibandingkan dengan t-test independent dan tidak ada perbedaan
statistik yang signifikan dari observasi yang dilakukan ( p>0.05).
Tabel 2 : Terdapat perbedaan statistik antara rata-rata dari gejala positif dan
negatif pada kedua kasus dan kelompok kontrol setelah ilakukan intervensi
(p>0.05). Pada akhirnya, terdapat perbedaan yang signifikan antara nilai
rata-rata dari gejala positif dan negatif sebelum dan sesudah intervensi pada
kelompok kasus.
Kelebihan dan Kelemahan Penelitian/ Strenght Limitation of The Study
Kelebihan : -
Kekurangan :
a. Pada penelitian ini hanya diberikan kepada pasien laki-laki.

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b. Pada penelitian ini tidak menjelaskan secara rinci bagaimana cara
memberika intervensi kepada pasien skiofrenia dengan gejala positif
dan negatif.
c. Penelitian ini dibatasi dalam beberapa hal seperti : status psikologi
sosial dari pasien selama wawancara dan kuesioner berlangsung, dan
juga olahraga yang memungkinkan untuk memberikan efek tentang
bagaimana mereka merespon dan berfungsi.
d. Hasil penelitian tidak bisa digeneralisasi atau di sama ratakan pada
seluruh pasien skizofrenia.
Critical Thingking
Senam aerobik merupakan tindakan yang dapat dilakukan untuk
mengurangi depresi pada seseorang khususnya pada laki laki. Seseorang yang
melakukan senam aerobik dengan durasi 20 menit dengan frekuensi 3 kali
seminggu menunjukkan penurunan tingkat depresi yang cukup signifikan. Karena
dengan melakukan senam aerobic dapat meningkatkan aliran darah ke otak,
meningkatkan nutrisi ke otak, menjaga fungsi otak, meningkatkan hipotalamus
dan memfasilitasi metabolisme neurotransmiter (Yuli,dkk,2015) dalam
Kuntaraf,2005.
Manfaat
Manfaat Teoritis :
1) Dengan adanya hasil penelitian ini akan dapat menambah pengetahuan
serta informasi mengenai efek senam aerobic secara teratur pada gejala
positif dan negatif terhadap pasien laki-laki dengan skizofrenia.
2) Jurnal ini bisa menjadi refrensi baru untuk penelitian selanjutnya.
Manfaat Praktis :
1) Dengan adanya hasil penelitian ini perawat dapat mengetahui
bagaimana cara memberikan asuhan keperawatan pada pasien
skizofrenia dengan gejala positif dan negatif.

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BAB IV
PENUTUP

4.1 Kesimpulan

Hasil dari penelitian ini menunjukkan bahwa statistikal efek yang signifikan dari
olahraga aerobic terhadap gejala positif dan negatif pada pasien skizofrenia.
4.2 Saran
a. Dengan adanya penelitian ini di harapkan akan dapat menambah pengetahuan
dan diharapkan dapat mengasah critical thingking pada perawat dalam
menyelesaikan masalah ataupun membahas mengenai efek senam aerobik
dengan gejala positif dan negatif pada pasien dengan skizofrenia kronis serta
dapat diaplikasikan di dunia keperawatan.
b. Untuk peneliti selanjutnya untuk melakukan penelitian yang hampir sama
seperti ini pada pasien skizofrenia berjenis kelamin perempuan.

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DAFTAR PUSTAKA

Keliat, Budi Anna. (2011). Manejemen Kasus Gangguan Jiwa. Buku Kedokteran : EGC.
Jakarta.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th
edition, Text revision, 1400 K Street, N.W, Washington, DC 2005; 2000. Hal: 298 306.

Astuti. (2014). Pengaruh Terapi Senam Aerobik Terhadap Keterbukaan Diri Pada Pasien
Isolasi Sosial di RSJD dr. Aminogondohutomo. Semarang.

Campbell P, Foxcroft D. (2008). Exercise Therapy For Schizophrenia (Protocol), The


Cochrane Collaboration. Published by John Wiley & Sons, Ltd, Liverpool Dalam,
Ermawati, et al. (2009). Asuhan Keperawatan Klien Dengan Gangguan Jiwa. Jakarta :
Trans Info Media.

Davies T, Craig T. (2009). ABC Kesehatan Mental : EGC. Jakarta

Yuli R, dkk. (2015). Efektifitas Senam Aerobic Low Impact Terhadap Penurunan Skor
Halusinasi Vol 2: Program Studi Ilmu Keperawatan. Universitas Riau

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