Do psychiatric patients benefit from physical and mental fitness training? Dutch mental health organisation the Trimbos Institute set out to investigate. Psychiatric patients follow a programme of fitness and breathing exercises with memory games and relaxation.

Emmy, hands trembling, enters cautiously and heads for a seat at the back of the room. Sam, a big man with a large belly, confidently occupies a place in the middle. They are joined by a young couple, and Ivan, a fit-looking man with a history of addiction. All are clients of a sheltered housing project in Utrecht.

“You can all take you coats off, because you’ll soon warm up,” says Perry Coppiëns, one of the trainers. After a brief explanation, the participants start on the first exercise. They have to lift their knees and clap their hands under their thighs. This they can all manage. It gets harder when they have to touch their knees and heels with their elbows. There is panting all round, and faces redden.

“Getting harder, eh? When you have to combine things, your brain soon goes ‘huh?’. But that’s OK. If everything’s easy, you don’t learn anything.”

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Laughter
The first participants collapse in their chairs. The trainer then explains an exercise for the left half of the brain: “Hold out one fist in front of you and hold the other fist against your chest with your little finger and thumb sticking out. Then change your hands over. The fist sticking out is always closed.” Soon everyone is laughing because hardly anyone can do it. Emmy does the exercise sitting down.

The group members suffer from depression, schizophrenia, anxiety disorders or addiction problems, Perry Coppiëns explains. 

“Research has shown that people with long-term psychiatric problems have difficulty with cognitive skills. Their memory, coordination and physical fitness are often poor. That’s why this training is so appropriate.”

Relaxation
Cognitive fitness is new to the Netherlands. Elsewhere in the world, this combination of breathing exercises, fitness and relaxation is uncommon, Coppiëns adds. “Only in America have there been small-scale initiatives. We set up the training programme with a neuropsychologist.” People deteriorate less quickly if they do physical and mental exercises, he says, citing research by the Dutch Mental Health Fund.

After a pilot programme last year, a second test group is about to start. Ivan was one of the first participants.

“It’s been a real benefit. My breathing and physical condition have improved. I’m sharper and more alert.”

This afternoon’s exercises aren’t easy for him either. One of the trainers taps Ivan’s left shoulder with his right hand, while Ivan does the same to him. Then they have to do two taps in succession. They soon mix up left and right, laugh, and start again.

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Drop-outs
The pilot group Ivan took part in was very positive about the training programme. By the end, their memory and cognitive skills had improved and their blood pressure was at a healthier level.

Nevertheless, more than half of the 40 participants dropped out. For some, the exercises were too hard, the mental problems too severe or the barrier of agoraphobia (fear of public spaces), too great. Perry Coppiëns:

"We’ve also had people with disabilities who did carry on. A partially-sighted woman, for example, or a man who walked with a stick. We adapted the exercises for them."

No evidence
Marcus Huibers is a psychotherapy professor at Maastricht University. He’s a supporter of treatment based on scientific research. The cognitive fitness method might work, he says, but there’s no evidence to prove it.

“You’d have to compare the group with a group that did no training to see what the effect was. I’m not sure if this training programme does any more than other treatment methods. It’s very important to activate these kinds of people, but I don’t know if this is the method. These patients aren’t always suited to group training, and they benefit more from tailor-made treatment.”

In his field there are many types of training on the market, he says. “They vary a lot, but they all have an average effect.” He doesn’t expect any miracles from cognitive fitness.

Enjoyable
Whether the training has any effect remains to be seen from the pilots. The Trimbos Institute plans to monitor a group that has no training to make a proper comparison. But even if the free training programme has no effect, at least the participants will have had 15 enjoyable afternoons.
 

The names of participants have been changed.