Outdoor activities were part of therapy in Victorian asylums, but with the
closure of large psychiatric hospitals, those activities became almost
extinct. Now a group of researchers is attempting to revive this
As Garfield the cartoon cat used to ask, “Are we having fun
“You bet!” a group of Canadians with schizophrenia would have
undoubtedly replied in July 2003. They were participating in an outdoor
program that is believed to be the first of its kind, at least in Canada and
the United States.
The program, Going Beyond, was conceived for people with severe mental
illness by Lakshmi N.P. Voruganti, M.D., an associate professor of psychiatry
at McMaster University in Hamilton, Ontario, and his coworkers. They modeled
it on the outward Bound philosophy, which focuses on developing inner
strength, character, and resolve by training the mind through the body with
challenging experiences in a supportive educational format.
Voruganti, also a consultant psychiatrist for st. Joseph's Healthcare in
Hamilton, and his team designed Going Beyond to have people with schizophrenia
engage in a variety of outdoor activities and sports—for instance,
camping, canoeing, kayaking, and rock climbing in the summer, and ice skating,
snowshoeing, snow-boarding, and skiing in the winter. The activities and
sports are coordinated and supervised by a recreation therapist, a nurse, a
social worker, and an occupational therapist while presenting novelty,
adventure, risk, and challenge.
The investigators examined the psychological and physical value of Going
Beyond in a small pilot study published in the august Canadian Journal of
Psychiatry. Twenty-three clinically stable individuals with
schizophrenia, and with an average age of 32, participated in the program for
eight months, while 31 such individuals, with an average age of 41, served as
controls. The controls received standard clinical care plus recreational
activities provided by the clinic—movie nights, dances, a summer picnic,
and a christmas party. All of the subjects were evaluated with standardized
rating scales at the start of the program, at the end, and a year thereafter.
Subjects' weights were recorded at quarterly intervals throughout the
While Going Beyond participants showed only marginal improvement in their
perceived cognitive abilities, the improvement was sustained a year later. In
contrast, the control group did not experience any improvement in their
perceived cognitive abilities at the end of the program period, and these
abilities remained the same or got slightly worse a year
Leaders and participants of the Going Beyond program pause for a group
shot. The program has been found to build participants' self-esteem and
improve global functioning.
Photo courtesy of Lakshmi N.P. Voruganti, M.D.
Moreover, Going Beyond participants experienced significant improvements in
self-esteem and global functioning by the end of the program, which were also
sustained a year later. In contrast, the control group exhibited no
perceptible changes in self-esteem and global functioning.
A few comments participants made about the program underscore the new zest
for life that it instilled in them. Said one: “We could do things and
not feel ashamed of ourselves.” Another noted, “This program
allowed me to think more clearly about my goals and values.”
Voruganti said his favorite comment was, “There are things I would
tell this group that I wouldn't tell my psychiatrist.”
Besides the cognitive and other benefits, the intervention group also lost,
on average, 12 pounds by the end of the eight-month program, whereas the
control group gained, on average, nine pounds in the same period. In fact, 18
of the 23 participants were able to maintain their weight loss a year after
the program was over, Voruganti told Psychiatric News.
“This novel recreation-based group intervention that, in its
preliminary evaluation, has 97 percent adherence, promotes significant weight
loss, and enhances self-esteem and functioning certainly deserves a closer
look,” Anthony Lehman, M.D., chair of psychiatry at the University of
Maryland and a major contributor to the American schizophrenia recovery
movement, said in an interview. “It literally offers a breath of fresh
“I don't think that the results of this study are surprising at
all,” Wesley Sowers, M.D., a past president of the American Association
of Community Psychiatrists and a member of the Coalition of Psychiatrists for
Recovery, commented. “When we think about the goals of recovery-focused
services and recovery in general, the idea is for people to take control of
Also heartened by their preliminary results, Voruganti and his team are now
launching an ambitious four-year randomized, double-blind, controlled trial
called the Diabetes Prevention Program in Schizophrenia. As Voruganti
explained, “It involves an evaluation of the feasibility of...
lifestyle-modification strategies in delaying or preventing the onset of
diabetes among people with schizophrenia who are detected to have raised
glucose and other metabolic abnormalities.”
And if the findings are positive, Voruganti and his group pointed out in
their report, “the practical implications would be enormous in terms of
addressing weight gain, type 2 diabetes, and other metabolic abnormalities
observed during long-term antipsychotic therapy.”
The study was sponsored by st. Joseph's Healthcare and supported in part by
an unrestricted educational grant from Novartis.
“Going Beyond: An Adventure- and Recreation-Based Group
Intervention Promotes Well-Being and Weight Loss in Schizophrenia” is