Introdução: A síndrome do intestino curto (SIC) representa um estado clínico de má absorção grave, e a gestão dietética de pacientes com SIC é extremamente desafiadora. Uma vez que o grau de desnutrição é frequentemente considerável, a intervenção dietética bem sucedida depende da estimativa mais exata possível das necessidades energéticas para prever as metas da terapia nutricional. Objetivo: Quantificar o gasto energético total (GET) em pacientes com SIC pelo método da água duplamente marcada (ADM). Materiais e Métodos: Neste estudo observacional, o GET foi mensurado pelo método da água duplamente marcada em 22 voluntários, 11 com SIC e 11 controles pareados por sexo, idade e IMC (grupo Controle). O GET foi estimado pela equação de Escott-Stump e a partir de acelerômetro, e foi comparado com o GET determinado pela ADM. O gasto energético em repouso (GER) foi mensurado por calorimetria indireta (CI) e comparado com o GER estimado pela equação de Harris e Benedict. O acelerômetro também foi utilizado para estabelecer o nível de atividade física. Resultados: Os participantes tinham idade (média ± DP) de 53 ± 8 anos. O GET medido por ADM foi significativamente menor no grupo SIC comparado ao grupo Controle (p < 0,01); no entanto, o GET estimado não diferiu significativamente entre os grupos. O GET medido foi significativamente maior do que o GET estimado por fórmula no grupo SIC, (respectivamente 1875 ± 276 e 1517 ± 175 kcal/dia, p < 0,01), assim como para o grupo Controle (2393 ± 445 e 1532 ± 178 kcal/dia, p < 0,01). No entanto, o GET medido foi significativamente menor do que o GET predito a partir do acelerômetro no grupo SIC (2075 ± 298 kcal/dia, p = 0,02), e não diferiu significativamente no grupo Controle (2207 ± 355 kcal/dia, p = 0,21). Não foram verificadas diferenças significantes entre o GER medido e predito para ambos, e entre os grupos. Conclusão: O GET medido em pacientes com SIC foi significativamente maior do que o GET estimado por fórmula, e foi menor quando comparado com os valores dos sujeitos controles. No entanto, o GET estimado a partir do acelerômetro, superestima o GET medido por ADM. As fórmulas atualmente utilizadas na prática clínica parecem subestimar as necessidades de energia de pacientes com SIC. Desta forma, adaptações da estimativa atual, aumentando as prescrições de ingestão energética nestes pacientes parecem ser adequadas para apoiar as necessidades diárias de energia e evitar a subnutrição. / Background: Short bowel syndrome (SBS) is a serious malabsorption disorder, and dietetic management of SBS patients is extremely challenging. Once the degree of undernutrition has been assessed, successful dietary intervention depends on the most accurate estimation and provision of energy needs to provide nutritional therapy goals. Objective: To quantify total energy expenditure (TEE) in SBS patients using the doubly labeled water (DLW) method. Design: In this observational study, TEE was measured by the DLW method in 22 participants, 11 with SBS and 11 gender-age-and BMI-matched controls (Control group). Predicted energy requirements were determined using the Escott-Stump equation and by using and accelerometer, and they were compared with TEE determined with DLW. Resting energy expenditure (REE) was measured using indirect calorimetry and compared with predict REE using the Harris and Benedict equation. The accelerometer was also used to determine physical activity level. Results: Participants were aged (mean ± SD) 53 ± 8 years. Measured TEE was significantly lower in the SBS group compared to the Control group (p < 0.01); however, predicted TEE did not differ significantly between the groups. Measured TEE was significantly higher than predicted TEE for the SBS group, (1875 ± 276 and 1517 ± 175 kcal/d, p < 0.01) and also for the Control group (2393 ± 445 and 1532 ± 178 kcal/d, p < 0.01) when determined by formula. However, measured TEE was significantly lower than predicted TEE (2075 ± 298 kcal/d, p = 0.02) for the SBS group, and did not differ for the Control group (2207 ± 355 kcal/d, p = 0.21) when determined by accelerometer. No significant differences were seen between measured and predicted REE both within and between groups. Conclusion: Measured TEE in SBS patients was significantly higher than predicted using standard equations, but also lower than values for age, BMI and gender-matched non-SBS controls. However, predicted TEE using accelerometer overestimated the measured TEE. Currently-used formulas in clinical practice appear to underestimate energy requirements of SBS patients. Therefore, adjustments to the current estimation, increasing the energy intake requirements in these patients appear to be adequate to support the daily energy requirements and avoid undernutrition.

A acidose metabólica é um achado comum em pacientes portadores de Doença Renal Crônica (DRC). Acredita-se que a dieta pode afetar o equilíbrio ácidobase do corpo por meio do fornecimento de precursores ácidos ou de base. No entanto, os resultados inconclusivos apontados na literatura indicam que ainda são necessários estudos bem delineados para comprovar a existência dessa associação. O principal objetivo desse estudo foi determinar o potencial de carga ácida renal (PRAL) proveniente da dieta e avaliar a sua associação com o bicarbonato sérico (HCO3) em pacientes com DRC enquanto em suas dietas habituais. Associações do HCO3 com o gasto energético de repouso (GER) e com oxidações proteicas e lipícas também foram estudadas. Trata-se de um estudo transversal realizado com 100 pacientes distribuídos igualmente nos estágios 3 e 4 da DRC entre 20 e 69 anos. Avaliação do estado nutricional foi feita por meio da antropometria, registro alimentar e exames bioquímicos, o qual incluiu os produtos proteicos de oxidação avançada e os isoprostanos. O HCO3 foi determinado por meio da gasometria venosa. GER foi medido pela calorimetria indireta. O PRAL foi determinado por meio do registro alimentar usando um algoritmo que inclui dados dietéticos da ingestão de proteína, fósforo, magnésio, cálcio e potássio descritos por Remer e Manz (1995). Também foi feita a diferenciação no consumo de proteína animal e vegetal. A análise dos resultados foi feita em quartis de HCO3 para as variáveis GER e parâmetros de oxidação, o restante das análises foram feitas por quartis de PRAL. Para comparação das variações médias dos quartis foi utilizado o teste one-way ANOVA. A associação entre a estimativa do PRAL e o HCO3 foi avaliada por modelos de regressão linear ajustados. A maior parte dos nossos pacientes portadores de DRC encontravam-se com excesso de peso associado a um aumento da circunferência abdominal e da porcentagem de gordura corporal. A mediana do PRAL foi de 6,8 mEq/dia com uma variação entre -24 a 52 mEq/dia. O PRAL mais elevado foi associado com o HCO3 mais baixo de uma forma graduada (p < 0.02). Encontramos uma diferença de 2,07 mmol/L no HCO3 entre o primeiro e o último quartil, sendo o valor do último quartil de PRAL menor em relação ao primeiro. A proteína animal apresentou uma correlação inversa com o bicarbonato sérico. O GER e os marcadores de oxidação lipíca e proteica não apresentaram associações com os níveis de HCO3. Esses resultados reforçam a possibilidade de que dietas com alto teor de carga ácida podem desempenhar um papel relevante no equilíbrio ácidobase em pacientes portadores de DRC, além de consolidar o uso da carga ácida da dieta como uma abordagem diferencial e complementar às outras estratégias no tratamento dietético da DRC. / Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD). Acid-inducing diets are believed to impact on acid-base balance. However, well-designed studies are still needed to prove the association between dietary acid load and serum bicarbonate. The main aim of this study was to calculate the potential renal acid load (PRAL) of selected, frequently consumed foods and to evaluate its association with serum bicarbonate (HCO3) in patients with CKD. Associations of HCO3 with resting energy expenditure (REE) and with protein and lipid oxidation were also studied. It is a cross-sectional study with 100 patients equally distributed in stages 3 and 4 of CKD between 20 and 69 years. Nutritional status was assessed by anthropometric measurements, 3-day food recall, biochemical analysis including advanced oxidation protein products and isoprostanes. Venous blood gases was used to measure HCO3. GER was measured by indirect calorimetry. PRAL was determined by food record using an algorithm that includes protein, phosphorus, magnesium, calcium and potassium intake described by Remer and Manz (1995). Dietary intake of animal and vegetable protein were also evaluate. For analysis, we used quartiles of HCO3 for GER and oxidation parameters and for the others variables we used quartilhes of PRAL. ANOVA one-way test was used to compare the mean of the quartiles. The association between PRAL and HCO3 was assessed by linear regression models. Most of the patients were overweight with increased waist circumference and body fat. The median PRAL was 6.8 mEq/day with a variation between -24 to 52 mEq/day. Higher PRAL was associated with lower serum bicarbonate in a graded fashion (P trend 0.02). Serum bicarbonate was 2.07 mEq/L lower among those in the highest compared with the lowest quartile of PRAL. Animal protein was inversely correlated with serum bicarbonate. REE and lipid and protein oxidation markers showed no association with HCO3 levels. These results reinforce the possibility that diets with high dietary acid load may play a relevant role in the acid-base balance in CKD patients. In addition to consolidating the use of PRAL as a differential and complementary approach to other strategies in the nutritional treatment of CKD.

Introdução: A síndrome do intestino curto (SIC) representa um estado clínico de má absorção grave, e a gestão dietética de pacientes com SIC é extremamente desafiadora. Uma vez que o grau de desnutrição é frequentemente considerável, a intervenção dietética bem sucedida depende da estimativa mais exata possível das necessidades energéticas para prever as metas da terapia nutricional. Objetivo: Quantificar o gasto energético total (GET) em pacientes com SIC pelo método da água duplamente marcada (ADM). Materiais e Métodos: Neste estudo observacional, o GET foi mensurado pelo método da água duplamente marcada em 22 voluntários, 11 com SIC e 11 controles pareados por sexo, idade e IMC (grupo Controle). O GET foi estimado pela equação de Escott-Stump e a partir de acelerômetro, e foi comparado com o GET determinado pela ADM. O gasto energético em repouso (GER) foi mensurado por calorimetria indireta (CI) e comparado com o GER estimado pela equação de Harris e Benedict. O acelerômetro também foi utilizado para estabelecer o nível de atividade física. Resultados: Os participantes tinham idade (média ± DP) de 53 ± 8 anos. O GET medido por ADM foi significativamente menor no grupo SIC comparado ao grupo Controle (p < 0,01); no entanto, o GET estimado não diferiu significativamente entre os grupos. O GET medido foi significativamente maior do que o GET estimado por fórmula no grupo SIC, (respectivamente 1875 ± 276 e 1517 ± 175 kcal/dia, p < 0,01), assim como para o grupo Controle (2393 ± 445 e 1532 ± 178 kcal/dia, p < 0,01). No entanto, o GET medido foi significativamente menor do que o GET predito a partir do acelerômetro no grupo SIC (2075 ± 298 kcal/dia, p = 0,02), e não diferiu significativamente no grupo Controle (2207 ± 355 kcal/dia, p = 0,21). Não foram verificadas diferenças significantes entre o GER medido e predito para ambos, e entre os grupos. Conclusão: O GET medido em pacientes com SIC foi significativamente maior do que o GET estimado por fórmula, e foi menor quando comparado com os valores dos sujeitos controles. No entanto, o GET estimado a partir do acelerômetro, superestima o GET medido por ADM. As fórmulas atualmente utilizadas na prática clínica parecem subestimar as necessidades de energia de pacientes com SIC. Desta forma, adaptações da estimativa atual, aumentando as prescrições de ingestão energética nestes pacientes parecem ser adequadas para apoiar as necessidades diárias de energia e evitar a subnutrição. / Background: Short bowel syndrome (SBS) is a serious malabsorption disorder, and dietetic management of SBS patients is extremely challenging. Once the degree of undernutrition has been assessed, successful dietary intervention depends on the most accurate estimation and provision of energy needs to provide nutritional therapy goals. Objective: To quantify total energy expenditure (TEE) in SBS patients using the doubly labeled water (DLW) method. Design: In this observational study, TEE was measured by the DLW method in 22 participants, 11 with SBS and 11 gender-age-and BMI-matched controls (Control group). Predicted energy requirements were determined using the Escott-Stump equation and by using and accelerometer, and they were compared with TEE determined with DLW. Resting energy expenditure (REE) was measured using indirect calorimetry and compared with predict REE using the Harris and Benedict equation. The accelerometer was also used to determine physical activity level. Results: Participants were aged (mean ± SD) 53 ± 8 years. Measured TEE was significantly lower in the SBS group compared to the Control group (p < 0.01); however, predicted TEE did not differ significantly between the groups. Measured TEE was significantly higher than predicted TEE for the SBS group, (1875 ± 276 and 1517 ± 175 kcal/d, p < 0.01) and also for the Control group (2393 ± 445 and 1532 ± 178 kcal/d, p < 0.01) when determined by formula. However, measured TEE was significantly lower than predicted TEE (2075 ± 298 kcal/d, p = 0.02) for the SBS group, and did not differ for the Control group (2207 ± 355 kcal/d, p = 0.21) when determined by accelerometer. No significant differences were seen between measured and predicted REE both within and between groups. Conclusion: Measured TEE in SBS patients was significantly higher than predicted using standard equations, but also lower than values for age, BMI and gender-matched non-SBS controls. However, predicted TEE using accelerometer overestimated the measured TEE. Currently-used formulas in clinical practice appear to underestimate energy requirements of SBS patients. Therefore, adjustments to the current estimation, increasing the energy intake requirements in these patients appear to be adequate to support the daily energy requirements and avoid undernutrition.

A acidose metabólica é um achado comum em pacientes portadores de Doença Renal Crônica (DRC). Acredita-se que a dieta pode afetar o equilíbrio ácidobase do corpo por meio do fornecimento de precursores ácidos ou de base. No entanto, os resultados inconclusivos apontados na literatura indicam que ainda são necessários estudos bem delineados para comprovar a existência dessa associação. O principal objetivo desse estudo foi determinar o potencial de carga ácida renal (PRAL) proveniente da dieta e avaliar a sua associação com o bicarbonato sérico (HCO3) em pacientes com DRC enquanto em suas dietas habituais. Associações do HCO3 com o gasto energético de repouso (GER) e com oxidações proteicas e lipícas também foram estudadas. Trata-se de um estudo transversal realizado com 100 pacientes distribuídos igualmente nos estágios 3 e 4 da DRC entre 20 e 69 anos. Avaliação do estado nutricional foi feita por meio da antropometria, registro alimentar e exames bioquímicos, o qual incluiu os produtos proteicos de oxidação avançada e os isoprostanos. O HCO3 foi determinado por meio da gasometria venosa. GER foi medido pela calorimetria indireta. O PRAL foi determinado por meio do registro alimentar usando um algoritmo que inclui dados dietéticos da ingestão de proteína, fósforo, magnésio, cálcio e potássio descritos por Remer e Manz (1995). Também foi feita a diferenciação no consumo de proteína animal e vegetal. A análise dos resultados foi feita em quartis de HCO3 para as variáveis GER e parâmetros de oxidação, o restante das análises foram feitas por quartis de PRAL. Para comparação das variações médias dos quartis foi utilizado o teste one-way ANOVA. A associação entre a estimativa do PRAL e o HCO3 foi avaliada por modelos de regressão linear ajustados. A maior parte dos nossos pacientes portadores de DRC encontravam-se com excesso de peso associado a um aumento da circunferência abdominal e da porcentagem de gordura corporal. A mediana do PRAL foi de 6,8 mEq/dia com uma variação entre -24 a 52 mEq/dia. O PRAL mais elevado foi associado com o HCO3 mais baixo de uma forma graduada (p < 0.02). Encontramos uma diferença de 2,07 mmol/L no HCO3 entre o primeiro e o último quartil, sendo o valor do último quartil de PRAL menor em relação ao primeiro. A proteína animal apresentou uma correlação inversa com o bicarbonato sérico. O GER e os marcadores de oxidação lipíca e proteica não apresentaram associações com os níveis de HCO3. Esses resultados reforçam a possibilidade de que dietas com alto teor de carga ácida podem desempenhar um papel relevante no equilíbrio ácidobase em pacientes portadores de DRC, além de consolidar o uso da carga ácida da dieta como uma abordagem diferencial e complementar às outras estratégias no tratamento dietético da DRC. / Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD). Acid-inducing diets are believed to impact on acid-base balance. However, well-designed studies are still needed to prove the association between dietary acid load and serum bicarbonate. The main aim of this study was to calculate the potential renal acid load (PRAL) of selected, frequently consumed foods and to evaluate its association with serum bicarbonate (HCO3) in patients with CKD. Associations of HCO3 with resting energy expenditure (REE) and with protein and lipid oxidation were also studied. It is a cross-sectional study with 100 patients equally distributed in stages 3 and 4 of CKD between 20 and 69 years. Nutritional status was assessed by anthropometric measurements, 3-day food recall, biochemical analysis including advanced oxidation protein products and isoprostanes. Venous blood gases was used to measure HCO3. GER was measured by indirect calorimetry. PRAL was determined by food record using an algorithm that includes protein, phosphorus, magnesium, calcium and potassium intake described by Remer and Manz (1995). Dietary intake of animal and vegetable protein were also evaluate. For analysis, we used quartiles of HCO3 for GER and oxidation parameters and for the others variables we used quartilhes of PRAL. ANOVA one-way test was used to compare the mean of the quartiles. The association between PRAL and HCO3 was assessed by linear regression models. Most of the patients were overweight with increased waist circumference and body fat. The median PRAL was 6.8 mEq/day with a variation between -24 to 52 mEq/day. Higher PRAL was associated with lower serum bicarbonate in a graded fashion (P trend 0.02). Serum bicarbonate was 2.07 mEq/L lower among those in the highest compared with the lowest quartile of PRAL. Animal protein was inversely correlated with serum bicarbonate. REE and lipid and protein oxidation markers showed no association with HCO3 levels. These results reinforce the possibility that diets with high dietary acid load may play a relevant role in the acid-base balance in CKD patients. In addition to consolidating the use of PRAL as a differential and complementary approach to other strategies in the nutritional treatment of CKD.

There is an increase in the prevalence of obesity among people with schizophrenia thought to be due in part to the weight enhancing side-effects of medications commonly used to treat the symptoms of schizophrenia. Despite the deleterious health effects associated with obesity and its impact on quality of life and medication compliance, little is known about body composition and energy expenditure in this clinical group. The primary purpose of this thesis was to enhance understanding of body composition and energy expenditure, particularly resting energy expenditure in men with schizophrenia who take atypical antipsychotic medications. Unique to this investigation is the evaluation of clinical tools used to predict body composition and energy expenditure against reference methodologies in men with schizophrenia. Further, given the known links between obesity and physical activity, an additional but less comprehensive component of the thesis was a consideration of total and activity energy expenditure in addition to the interaction between psychiatric symptoms, side-effects of antipsychotic medications and physical activity also occurred as part of this thesis. Collectively, the goals of this thesis were addressed through a series of studies – the first two studies were related to the measurement and characteristics of body composition in men with schizophrenia, while the third and fourth studies were related to the measurement and characteristics of resting energy expenditure in men with schizophrenia. The fifth and sixth studies the utilised doubly labelled water technique to quantify activity and total energy expenditure in a small group of men with schizophrenia and explored the use of accelerometry in this cohort. The final study briefly considered the impact of psychiatric symptoms and self-reported medication side-effects on objectively measured physical activity. In the first study, thirty-one male adults previously diagnosed with schizophrenia and sixteen healthy male controls were recruited. Estimates of body composition derived from an anthropometry-based equation and from bioelectric impedance analysis (BIA) using deuterium dilution as the reference methodology to determine total body water were compared. The study also determined the validity of equations commonly used to predict body composition from BIA in the men with schizophrenia. A further aim was to determine the superiority of either BIA or body mass index (BMI) as an indicator of obesity in this cohort. The inclusion of the control group, closely matched for age, body size and body composition demonstrated that there was no difference in the ability of body composition prediction methods to distinguish between fat and fat-free mass (FFM) in controls and men with schizophrenia when both groups had similar body composition. However this study indicated that an anthropometry-based equation previously used in people with schizophrenia was a poor predictor of body composition in this cohort, as evidenced by wide limits of agreement (25%) and systematic variation of the bias. In comparison, the best predictor of percentage body fat (%BF) in this group was gained when impedance values were used to predict percentage body fat via the equation published by Lukaski et al (1986). Although percentage body fat was underpredicted using the Lukaski et al. (1986) equation, the mean magnitude was relatively small (1.3%), with the limits of agreement approximately 13%. Linear regression analysis revealed that %BF predicted using the Lukaski et al. (1986) equation explained 25% more of the variance in percentage body fat than BMI. Further, this study also indicated that BIA was more sensitive than BMI in distinguishing between overweight and obesity in this cohort of men with schizophrenia. Because of the almost exclusive use of BMI as an indicator of obesity in people with schizophrenia, the level of excess body fat may be in excess of that previously indicated. The second study extended the examination of body composition in men with schizophrenia. In this study, the thirty-one participants with schizophrenia (age, 34.2 ± 5.7 years; BMI, 30.2 ± 5.7 kg/m2) were individually matched with sedentary controls by age, weight and BMI. Deuterium dilution was used to distinguish between FFM and fat mass. The previous study had indicated that while BIA was a suitable group measure for obesity, on an individual level the technique lacked the precision required for investigating body composition in men with schizophrenia. Waist circumference was used as an indicator of body fat distribution. The findings of this study indicated that in comparison with healthy sedentary controls of similar body size and age, men with schizophrenia had higher levels of body fat which was more centrally distributed. Percentage body fat was on average 4% higher and waist circumference, on average 5 cm greater in men with schizophrenia than the sedentary controls of the same age and BMI. Further, this study indicates that the use of BMI to predict body fat in men with schizophrenia will result in greater bias than when it is used to predict body fat in other sedentary men. Commonly used regression equations to predict energy requirements at rest are based on the relationships between weight and resting energy expenditure (REE) and in such equations, weight acts as a surrogate measure of FFM. The objectives of study three were to measure REE in a small group of men with schizophrenia who were taking the antipsychotic medication clozapine and to determine whether REE can be predicted with sufficient accuracy to substitute for the measurement of REE in the clinical and/or research settings. Body composition was determined using deuterium dilution and REE was measured using a Deltatrac Metabolic Cart via a ventilated hood. The male participants, (aged 28.0 ± 6.7 yrs, BMI 29.8 ± 6.8 kg/m2) were weight stable at the time of the study and had been taking clozapine for 20.5 ± 12.8 months, with doses of 450 ± 140 mg/day. Of the six prediction equations evaluated, the equation of Mifflin et al. (1990) with no systematic bias, the lowest bias and the lowest limits of agreement proved to be the most suitable equation to predict REE in this cohort. The overestimation of REE can be corrected for by deducting 160 kcal/day from the predicted REE value when using the Mifflin et al. (1990) equations. However, the magnitude of the error associated with the prediction of REE for an individual is 370 kcal/day. The findings of this study indicate that REE cannot be predicted with sufficient individual accuracy in men with schizophrenia, therefore it was necessary to measure rather than predict REE in subsequent studies. In the fourth study, indirect calorimetry (Deltatrac Metabolic Cart via ventilated hood) and deuterium dilution were used to accurately determine REE, respiratory quotient (RQ) and FFM in 31 men with schizophrenia and healthy sedentary controls individually matched for age and BMI. Data from this study indicated that gross REE was lower in men with schizophrenia than in healthy sedentary controls of a similar age and body size. However, there was no difference between the groups in REE when REE was adjusted for FFM using the mathematically correct method (analysis of covariance with FFM as the covariate). There was however a statistically and clinically significant difference in resting, fasted RQ between men with schizophrenia and controls, suggesting that RQ rather than REE may be an important correlate worthy of further investigation in men with schizophrenia who take antipsychotic medications. Studies five and six involved the application of the doubly labelled water (DLW) technique to accurately determine total energy expenditure (TEE) and activity energy expenditure (AEE) in a small group of men with schizophrenia who had been taking the atypical antipsychotic medication clozapine. The participants were those who took part in study three. The purpose of these studies was to assess the validity of a commercially available tri-axial accelerometer (RT3) for predicting free-living AEE and to investigate TEE and AEE in men with schizophrenia. There was poor agreement between AEE measured using DLW and AEE predicted using the RT3. However, using the RT3 to measure inactivity explained over two-thirds of the variance in AEE. This study found that the relationship between current AEE per kilogram of body weight and change from baseline weight in men taking clozapine was strong although not significant. The sedentary nature of the group of participants in this study was reflected in physical activity levels, (PAL, 1.39 ± 0.27), AEE (435 ±352 kcal/day) and TEE (2511 ± 606 kcal/day) that fell well short of values recommended by WHO (2000) for optimal health and to prevent weight gain. Given the increasing recognition of the importance of sedentary behaviour to weight gain in the general community, further examination of the unique contributing factors such as medication side effects and symptoms of mental illness to activity levels in this clinical group is warranted. The final study used accelerometry (RT3) to objectively measure activity in a group of 31 men with schizophrenia who had been taking atypical antipsychotic medications for more than four months. The purpose of this study was to explore the relationships between psychiatric symptomatology, side-effects of medication and physical activity. Accelerometry output was analysed to provide a measure of inactivity and moderate intensity activity (MIA). The well-validated and reliable standardised clinical interview, the Positive and Negative Syndrome Scale (PANSS) was used as a measure of psychiatric symptoms. Perceived side-effects of medication were assessed using the Liverpool University Neuroleptic Rating Side-Effects Scale (LUNSER). Surprisingly, there was no relationship reported between any measures of negative symptoms and physical inactivity. However, self-reported measures of medication side-effects relating to fatigue, sleepiness during the day and extrapyramidal symptoms explained 40% of the variance in inactivity. This study found significant relationships between some negative symptoms and moderate intensity activity. Despite the expectation that as symptoms of mental illness reduce, inactivity may diminish and moderate intensity activity will increase, it may not be surprising that in practice this is an overly simplistic view. It may be that measures of social functioning and possibly therefore cognition may be better predictors of physical activity than psychiatric symptomatology per se.