1
|
Leroux E, Tréhout M, Reboursiere E, de Flores R, Morello R, Guillin O, Quarck G, Dollfus S. Effects of web-based adapted physical activity on hippocampal plasticity, cardiorespiratory fitness, symptoms, and cardiometabolic markers in patients with schizophrenia: a randomized, controlled study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01818-8. [PMID: 38740618 DOI: 10.1007/s00406-024-01818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Among the lifestyle interventions, the physical activity (PA) has emerged as an adjuvant non-pharmacological treatment improving mental and physical health in patients with schizophrenia (SZPs) and increasing the hippocampus (HCP) volume. Previously investigated PA programs have been face-to-face, and not necessary adapted to patients' physiological fitness. We propose an innovative 16-week adapted PA program delivered by real-time videoconferencing (e-APA), allowing SZPs to interact with a coach and to manage their physical condition. The primary goal was to demonstrate a greater increase of total HCP volumes in SZPs receiving e-APA compared to that observed in a controlled group. The secondary objectives were to demonstrate the greater effects of e-APA compared to a controlled group on HCP subfields, cardiorespiratory fitness, clinical symptoms, cognitive functions, and lipidic profile. Thirty-five SZPs were randomized to either e-APA or a controlled group receiving a health education program under the same conditions (e-HE). Variables were assessed at pre- and post-intervention time-points. The dropout rate was 11.4%. Compared to the e-HE group, the e-APA group did not have any effect on the HCP total volumes but increased the left subiculum volume. Also, the e-APA group significantly increased cardiorespiratory fitness (VO2max), improved lipidic profile and negative symptoms but not cognitive functions. This study demonstrated the high feasibility and multiple benefits of a remote e-APA program for SZPs. e-APA may increase brain plasticity and improve health outcomes in SZPs, supporting that PA should be an add-on therapeutic intervention. ClinicalTrial.gov on 25 august 2017 (NCT03261817).
Collapse
Affiliation(s)
- E Leroux
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France.
| | - M Tréhout
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
- Centre Esquirol, Service de Psychiatrie Adulte, CHU de Caen Normandie, 14000, Caen, France
| | - E Reboursiere
- Service de Médecine du Sport, CHU de Caen Normandie, 14000, Caen, France
| | - R de Flores
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
| | - R Morello
- Unité de Biostatistiques et Recherche Clinique, CHU de Caen Normandie, 14000, Caen, France
| | - O Guillin
- SHU du Rouvray, 76300, Sotteville-lès-Rouen, France
- Normandie Univ, UFR de Médecine, 76000, Rouen, France
- CHU de Rouen, 76000, Rouen, France
| | - G Quarck
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000, Caen, France
| | - S Dollfus
- PhIND "Physiopathology and Imaging of Neurological Disorders", UMR-S U1237, GIP CYCERON, INSERM, CYCERON, CHU de Caen Normandie, Normandie Univ, Université de Caen Normandie, Campus Jules Horowitz, Bd Henri Becquerel, BP 5229, 14074, Caen, France
- Centre Esquirol, Service de Psychiatrie Adulte, CHU de Caen Normandie, 14000, Caen, France
- Université de Caen Normandie, Normandie Univ, UFR de Santé, 14000, Caen, France
| |
Collapse
|
2
|
Roell L, Keeser D, Papazov B, Lembeck M, Papazova I, Greska D, Muenz S, Schneider-Axmann T, Sykorova EB, Thieme CE, Vogel BO, Mohnke S, Huppertz C, Roeh A, Keller-Varady K, Malchow B, Stoecklein S, Ertl-Wagner B, Henkel K, Wolfarth B, Tantchik W, Walter H, Hirjak D, Schmitt A, Hasan A, Meyer-Lindenberg A, Falkai P, Maurus I. Effects of Exercise on Structural and Functional Brain Patterns in Schizophrenia-Data From a Multicenter Randomized-Controlled Study. Schizophr Bull 2024; 50:145-156. [PMID: 37597507 PMCID: PMC10754172 DOI: 10.1093/schbul/sbad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Aerobic exercise interventions in people with schizophrenia have been demonstrated to improve clinical outcomes, but findings regarding the underlying neural mechanisms are limited and mainly focus on the hippocampal formation. Therefore, we conducted a global exploratory analysis of structural and functional neural adaptations after exercise and explored their clinical implications. STUDY DESIGN In this randomized controlled trial, structural and functional MRI data were available for 91 patients with schizophrenia who performed either aerobic exercise on a bicycle ergometer or underwent a flexibility, strengthening, and balance training as control group. We analyzed clinical and neuroimaging data before and after 6 months of regular exercise. Bayesian linear mixed models and Bayesian logistic regressions were calculated to evaluate effects of exercise on multiple neural outcomes and their potential clinical relevance. STUDY RESULTS Our results indicated that aerobic exercise in people with schizophrenia led to structural and functional adaptations mainly within the default-mode network, the cortico-striato-pallido-thalamo-cortical loop, and the cerebello-thalamo-cortical pathway. We further observed that volume increases in the right posterior cingulate gyrus as a central node of the default-mode network were linked to improvements in disorder severity. CONCLUSIONS These exploratory findings suggest a positive impact of aerobic exercise on 3 cerebral networks that are involved in the pathophysiology of schizophrenia. CLINICAL TRIALS REGISTRATION The underlying study of this manuscript was registered in the International Clinical Trials Database, ClinicalTrials.gov (NCT number: NCT03466112, https://clinicaltrials.gov/ct2/show/NCT03466112?term=NCT03466112&draw=2&rank=1) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).
Collapse
Affiliation(s)
- Lukas Roell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Neuroimaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Neuroimaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Irina Papazova
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - David Greska
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Muenz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Eliska B Sykorova
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christina E Thieme
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Charlotte Huppertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Katriona Keller-Varady
- Hannover Medical School, Department of Rehabilitation and Sports Medicine, Hannover, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, University Hospital Charité Berlin, Berlin, Germany
| | - Wladimir Tantchik
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Dusan Hirjak
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
3
|
Associations between aerobic fitness, negative symptoms, cognitive deficits and brain structure in schizophrenia—a cross-sectional study. SCHIZOPHRENIA 2022; 8:63. [PMID: 35918344 PMCID: PMC9345912 DOI: 10.1038/s41537-022-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022]
Abstract
Negative symptoms and cognitive deficits are common in individuals with schizophrenia, greatly affect their outcome, and have been associated with alterations in cerebral gray and white matter volume (GMV, WMV). In the last decade, aerobic endurance training has emerged as a promising intervention to alleviate these symptoms and improved aerobic fitness has been suggested as a key moderator variable. In the present study, we investigated, whether aerobic fitness is associated with fewer cognitive deficits and negative symptoms and with GMVs and WMVs in individuals with schizophrenia in a cross-sectional design. In the largest study to date on the implications of fitness in individuals with schizophrenia, 111 participants at two centers underwent assessments of negative symptoms, cognitive functioning, and aerobic fitness and 69 underwent additional structural magnetic resonance imaging. Multilevel Bayesian partial correlations were computed to quantify relationships between the variables of interest. The main finding was a positive association of aerobic fitness with right hippocampal GMV and WMVs in parahippocampal and several cerebellar regions. We found limited evidence for an association of aerobic fitness with cognitive functioning and negative symptoms. In summary, our results strengthen the notion that aerobic fitness and hippocampal plasticity are interrelated which holds implications for the design of exercise interventions in individuals with schizophrenia.
Collapse
|
4
|
Falkai P, Schmitt A, Rosenbeiger CP, Maurus I, Hattenkofer L, Hasan A, Malchow B, Heim-Ohmayer P, Halle M, Heitkamp M. Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine. Eur Arch Psychiatry Clin Neurosci 2022; 272:643-677. [PMID: 34873635 PMCID: PMC9095557 DOI: 10.1007/s00406-021-01360-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022]
Abstract
Major depression, bipolar disorder, and schizophrenia are severe mental illnesses. Despite receiving psychopharmacological and psychosocial treatments, about half of patients develop a chronic course with residual cognitive and negative symptoms and have a high risk for cardiovascular disease and reduced life expectancy. Therefore, add-on innovative treatment approaches are needed to improve outcome. Aerobic exercise interventions have been shown to improve global functioning, cognition, and negative and depressive symptoms in these patients. The basic mechanism of these exercise-related changes has been reported to be improved brain plasticity, e.g., increased volume of disease-related brain regions such as the hippocampus. The optimal type, duration, and frequency of exercise have not yet been determined and need to be addressed in supervised physical exercise studies. Because of the low physical activity levels, lack of drive related to negative and depressive symptoms, and high prevalence of cardiovascular comorbidities in patients with severe mental illness, besides aiming to improve symptoms of mental illness, exercise interventions should also aim to increase cardiorespiratory fitness, which they should comprehensively assess by direct measurements of maximal oxygen uptake. Based on the recommendations for developing cardiorespiratory fitness by the American College of Sports Medicine, 150 min moderate-intensity training per week or vigorous-intensity exercise training for 75 min per week are appropriate. Most studies have had relatively short intervention periods, so future studies should focus on long-term adherence to exercise by implementing motivational strategies supported by telemedicine and by identifying and targeting typical barriers to exercise in this patient population.
Collapse
Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Christian P. Rosenbeiger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Lisa Hattenkofer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Pascale Heim-Ohmayer
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany ,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Melanie Heitkamp
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
| |
Collapse
|
5
|
Roell L, Maurus I, Keeser D, Karali T, Papazov B, Hasan A, Schmitt A, Papazova I, Lembeck M, Hirjak D, Sykorova E, Thieme CE, Muenz S, Seitz V, Greska D, Campana M, Wagner E, Loehrs L, Stoecklein S, Ertl-Wagner B, Poemsl J, Roeh A, Malchow B, Keller-Varady K, Meyer-Lindenberg A, Falkai P. Association between aerobic fitness and the functional connectome in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:1253-1272. [PMID: 35488054 PMCID: PMC9508005 DOI: 10.1007/s00406-022-01411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Schizophrenia is accompanied by widespread alterations in static functional connectivity associated with symptom severity and cognitive deficits. Improvements in aerobic fitness have been demonstrated to ameliorate symptomatology and cognition in people with schizophrenia, but the intermediary role of macroscale connectivity patterns remains unknown. OBJECTIVE Therefore, we aim to explore the relation between aerobic fitness and the functional connectome in individuals with schizophrenia. Further, we investigate clinical and cognitive relevance of the identified fitness-connectivity links. METHODS Patients diagnosed with schizophrenia were included in this cross-sectional resting-state fMRI analysis. Multilevel Bayesian partial correlations between aerobic fitness and functional connections across the whole brain as well as between static functional connectivity patterns and clinical and cognitive outcome were performed. Preliminary causal inferences were enabled based on mediation analyses. RESULTS Static functional connectivity between the subcortical nuclei and the cerebellum as well as between temporal seeds mediated the attenuating relation between aerobic fitness and total symptom severity. Functional connections between cerebellar seeds affected the positive link between aerobic fitness and global cognition, while the functional interplay between central and limbic seeds drove the beneficial association between aerobic fitness and emotion recognition. CONCLUSION The current study provides first insights into the interactions between aerobic fitness, the functional connectome and clinical and cognitive outcome in people with schizophrenia, but causal interpretations are preliminary. Further interventional aerobic exercise studies are needed to replicate the current findings and to enable conclusive causal inferences. TRIAL REGISTRATION The study which the manuscript is based on is registered in the International Clinical Trials Database (ClinicalTrials.gov identifier [NCT number]: NCT03466112) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).
Collapse
Affiliation(s)
- Lukas Roell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany. .,NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany.
| | - Isabel Maurus
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Daniel Keeser
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany ,grid.411095.80000 0004 0477 2585NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
| | - Temmuz Karali
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany ,grid.411095.80000 0004 0477 2585NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
| | - Boris Papazov
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- grid.7307.30000 0001 2108 9006Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.11899.380000 0004 1937 0722Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Irina Papazova
- grid.7307.30000 0001 2108 9006Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Moritz Lembeck
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Dusan Hirjak
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Eliska Sykorova
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Cristina E. Thieme
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Susanne Muenz
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Valentina Seitz
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - David Greska
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Mattia Campana
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Elias Wagner
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Lisa Loehrs
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Sophia Stoecklein
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany ,grid.42327.300000 0004 0473 9646Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Johannes Poemsl
- grid.15474.330000 0004 0477 2438Department of Psychiatry and Psychotherapy, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts Der Isar’, Munich, Germany
| | - Astrid Roeh
- grid.7307.30000 0001 2108 9006Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Berend Malchow
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Katriona Keller-Varady
- grid.492118.70000 0004 0619 212XHannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - Andreas Meyer-Lindenberg
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| |
Collapse
|
6
|
Maurus I, Hasan A, Schmitt A, Roeh A, Keeser D, Malchow B, Schneider-Axmann T, Hellmich M, Schmied S, Lembeck M, Keller-Varady K, Papazova I, Hirjak D, Topor CE, Walter H, Mohnke S, Vogel BO, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P. Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:315-324. [PMID: 32748261 PMCID: PMC8257533 DOI: 10.1007/s00406-020-01175-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/22/2020] [Indexed: 12/20/2022]
Abstract
Even today, patients with schizophrenia often have an unfavorable outcome. Negative symptoms and cognitive deficits are common features in many patients and prevent recovery. In recent years, aerobic endurance training has emerged as a therapeutic approach with positive effects on several domains of patients' health. However, appropriately sized, multicenter randomized controlled trials that would allow better generalization of results are lacking. The exercise study presented here is a multicenter, rater-blind, two-armed, parallel-group randomized clinical trial in patients with clinically stable schizophrenia being conducted at five German tertiary hospitals. The intervention group performs aerobic endurance training on bicycle ergometers three times per week for 40-50 min/session (depending on the intervention week) for a total of 26 weeks, and the control group performs balance and tone training for the same amount of time. Participants are subsequently followed up for 26 weeks. The primary endpoint is all-cause discontinuation; secondary endpoints include psychopathology, cognition, daily functioning, cardiovascular risk factors, and explorative biological measures regarding the underlying mechanisms of exercise. A total of 180 patients will be randomized. With currently 162 randomized participants, our study is the largest trial to date to investigate endurance training in patients with schizophrenia. We hypothesize that aerobic endurance training has beneficial effects on patients' mental and physical health, leading to lower treatment discontinuation rates and improving disease outcomes. The study results will provide a basis for recommending exercise interventions as an add-on therapy in patients with schizophrenia.The study is registered in the International Clinical Trials Database (ClinicalTrials.gov identifier [NCT number]: NCT03466112) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).
Collapse
Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Astrid Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Martin Hellmich
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Faculty of Medicine, Clinical Trials Centre Cologne, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | | | - Irina Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Dusan Hirjak
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Cristina E Topor
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Frank Schneider
- University Hospital, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Andreas Meyer-Lindenberg
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| |
Collapse
|
7
|
Schmitt A, Reich-Erkelenz D, Falkai P. Impact of the metabolic syndrome on severe mental disorders. Eur Arch Psychiatry Clin Neurosci 2020; 270:499-500. [PMID: 32588131 PMCID: PMC7332478 DOI: 10.1007/s00406-020-01156-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstrasse 7, 80336, Munich, Germany.
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nußbaumstrasse 7, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstrasse 7, 80336 Munich, Germany
| |
Collapse
|
8
|
The impact of endurance training and table soccer on brain metabolites in schizophrenia. Brain Imaging Behav 2019; 14:515-526. [PMID: 31686308 DOI: 10.1007/s11682-019-00198-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Higher glutamate and glutamine (together: Glx) and lower N-acetyl-aspartate (NAA) levels were reported in schizophrenia. Endurance training normalizes NAA in the hippocampus, but its effects on other metabolites in the brain and the relationship of metabolites to clinical symptoms remain unknown. For 12 weeks, 20 schizophrenia inpatients (14 men, 6 women) and 23 healthy controls (16 men, 7 women) performed endurance training and a control group of 21 schizophrenia inpatients (15 men, 6 women) played table soccer. A computer-assisted cognitive performance training program was introduced after 6 weeks. We assessed cognitive performance, psychopathological symptoms, and everyday functioning at baseline and after 6 and 12 weeks and performed single voxel magnetic resonance spectroscopy of the hippocampus, left dorsolateral prefrontal cortex (DLPFC), and thalamus. We quantified NAA, Glx, total creatine (tCr), calculated NAA/tCr and Glx/tCr and correlated these ratios with physical fitness, clinical and neurocognitive scores, and everyday functioning. At baseline, in both schizophrenia groups NAA/tCr was lower in the left DLPFC and left hippocampus and Glx/tCr was lower in the hippocampus than in the healthy controls. After 6 weeks, NAA/tCr increased in the left DLPFC in both schizophrenia groups. Brain metabolites did not change significantly in the hippocampus or thalamus, but the correlation between NAA/tCr and Glx/tCr normalized in the left DLPFC. Global Assessment of Functioning improvements correlated with NAA/tCr changes in the left DLPFC. In our study, endurance training and table soccer induced normalization of brain metabolite ratios in the brain circuitry associated with neuronal and synaptic elements, including metabolites of the glutamatergic system.
Collapse
|