Effects of high intensity interval training among overweight individuals with psychotic disorders: A randomized controlled trial

Effect of an adapted physical activity program on stress, anxiety, depression in patients with schizophrenia: study protocol of a randomized-controlled trial

Physical activity (PA) is recommended to optimize well-functioning in people with schizophrenia. PA has been found to improve quality of life, general symptomatology, depression, anxiety and stress symptoms, global and social functioning. In PA research, most of the interventions are based on one-on-one interventions but there is poor information about group-based PA interventions. Using a randomized controlled, clinician-blinded trial, subjects are randomized into two arms: the PA group or control group. Our first objective is about to evaluate the effects of a multimodal 6 week collective PA intervention on depression, anxiety, and stress symptoms in people with schizophrenia. Our second objective is about to evaluate these effects on secondary outcomes especially smoking, well-being, physical fitness and on care utilization. All participants are evaluated before and after the 6 week intervention period, and only participants in the PA group are called in a follow-up interview 3 and 6 months after the intervention.Trial registration Individual Protection Committee of Ile-de-France II, n ID RCB: 2018- A00583-52. Registered on 8 April 2018.

Systematic Review and Meta-analysis of Exercise Interventions for Psychotic Disorders: The Impact of Exercise Intensity, Mindfulness Components, and Other Moderators on Symptoms, Functioning, and Cardiometabolic Health

BACKGROUND AND HYPOTHESIS

Exercise therapy has been shown to be an effective complementary treatment for patients with psychotic disorders. However, the specific impacts of different training modalities remain poorly understood. This article aims to quantitatively review the moderating influence of different exercise modalities, hypothesizing that higher exercise intensity as well as utilization of mindfulness-based exercise (MBE) components, will improve intervention outcomes.

STUDY DESIGN

PubMed, Web of Science, and PsycINFO were searched from 2010 to March 2022 for randomized controlled trials investigating exercise interventions in patients with psychotic disorders (preregistration: https://doi.org/10.17605/OSF.IO/J8QNS). Outcomes considered were positive/negative symptoms, Positive and Negative Syndrome Scale (PANSS) General Psychopathology/Total scores, depressive symptoms, psychosocial functioning, quality of life, cardiorespiratory fitness, and body mass index. Separate meta-analyses, including moderator analyses, were performed to evaluate the moderating influence of different training modalities.

STUDY RESULTS

Of 6653 studies, 40 (n = 2111 patients) were included in the meta-analysis. The effects of moderate-intensity exercise exceed low-intensity approaches for PANSS Total scores (P = .02) and depressive symptoms (P = .04). The presence of MBE components was associated with improvements in positive symptoms (P = .04) and PANSS General Psychopathology subscores (P = .04) but also with higher error and between-study heterogeneity. Our analysis also shows improved intervention effects on depression in younger patients (P = .012) and improved psychosocial functioning scores following more frequent sessions (P < .01).

CONCLUSIONS

A minimum of moderate intensity should be considered. More frequent training sessions per week also seem to be beneficial. While adding mindfulness elements is promising, it increases heterogeneity and requires caution in terms of generalization.

Comparative efficacy of different types of exercise modalities on psychiatric symptomatology in patients with schizophrenia: a systematic review with network meta-analysis

This network meta-analysis investigated the effects of 8 types of physical exercises on treating positive symptoms, negative symptoms, general psychopathology, and the Positive And Negative Syndrome Scale (PANSS) total score in patients with schizophrenia. The methods adhered to PRISMA guidelines and used the Cochrane risk of bias tool for quality assessment, and Stata software for data analysis. Data were sourced from PubMed, Embase, Web of Science, and the Cochrane database up to August 15, 2023, following PICOS principles. A total of 25 studies including 1441 participants were analyzed. Results showed that resistance exercise seems to be effective for improving positive symptoms, while Yoga was more effective for negative symptoms. Low-intensity aerobic exercise was optimal for general psychopathology, and Yoga was effective in improving the PANSS total score. The study concluded that yoga and aerobic exercise demonstrated superior performance, but the impact of exercise on patients with schizophrenia is also influenced by individual factors and intervention dosages. Therefore, a pre-assessment of patients considering factors such as interests, hobbies, and physical capabilities is crucial for selecting appropriate exercise modalities.

Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses

BACKGROUND

To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT).

METHODS

Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis.

RESULTS

One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence.

CONCLUSIONS

Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints.

REGISTRATION

This review was registered in the PROSPERO database and given the identifier CRD42019103313.

Antipsychotic-Induced Metabolic Syndrome: A Review

Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipid abnormalities. Indeed, the risk of metabolic syndrome would be increased in the population with schizophrenia compared to the general population. The objective is to summarize the prevalence, the mechanisms, and the potential treatments of antipsychotic-induced metabolic syndrome. This is a narrative review of the literature. We searched the electronic database Medline, accessed through PubMed, to find studies that investigated the prevalence and treatments of metabolic syndrome in the adult population using antipsychotics. The prevalence of metabolic syndrome in patients treated with antipsychotics ranges from 37% to 63%. Antipsychotic iatrogenic effects include weight gain/increased waist circumference, dyslipidemia, insulin resistance/type 2 diabetes, and hypertension. Clozapine and olanzapine are reported to precipitate the onset of metabolic syndrome features. In patients with metabolic syndrome, an antipsychotic with less metabolic side effects such as lurasidone, lumateperone, ziprasidone, and aripiprazole should be prioritized. Unlike medications, aerobic exercise and dietetic counseling were found to be efficient as the nonpharmacologic treatment of antipsychotic-induced metabolic syndrome. Few pharmacological treatments were proven effective against weight gain in this patient population. The risk of metabolic syndrome induced by antipsychotics should be early recognized and closely monitored. Primary and secondary prevention of metabolic syndrome or onset of its feature might help reduce the risk of death for patients using antipsychotics.

The effect of exercise on global, social, daily living and occupational functioning in people living with schizophrenia: A systematic review and meta-analysis

BACKGROUND

Schizophrenia is associated with high rates of global, social and occupational functional impairments. While prior meta-analyses have extensively examined the impact of exercise on physical and mental health, the impact on functioning in schizophrenia have yet to be fully established. This review aimed to update the evidence base regarding the impact of exercise on functioning in schizophrenia, and explore moderators of effect.

METHODS

A systematic search was conducted to identify randomized controlled trials (RCTs) of exercise evaluating global functioning versus any comparator in people with schizophrenia; between group meta-analyses of global functioning (and secondary - social, living skills, occupational, adverse events) were computed using a random effects model. Subgroup analyses based on diagnosis and aspects of the intervention were conducted.

RESULTS

18 full text articles were included, involving 734 participants. A moderate impact of exercise on global functioning was found (g = 0.40, 95 % C·I. = 0.12 to 0.69, p = 0.006), with a moderate impact of exercise on social (N = 5, g = 0.54 95 % C.I = 0.16 to 0.9 p = 0.005), and daily living functioning (N = 3, g = 0.65, 95 % C.I. = 0.07 to 1.22, p = 0.005).

CONCLUSIONS

There is good evidence that exercise can improve the global functioning of people with schizophrenia, with preliminary evidence for social and daily living skills; exercise should be considered an important adjunct to usual care. Higher impacts on global functioning were seen in aerobic interventions and of at least moderate to vigorous intensity. More research is required into resistance training, in early psychosis cohorts and to evaluate the comparison of exercise with other established psychosocial therapies.

Effects of exercise intervention on psychotic symptoms: A meta-analysis and hypothetical model of neurobiological mechanisms

There is conflicting evidence on the efficacy of exercise as intervention for psychosis. This article aims to analyze the effect of exercise on psychotic symptoms. A database search was conducted in PubMed, Web of Science, Scopus, ScienceDirect, EBSCO and Cochrane CENTRAL, based on a protocol (PROSPERO: CRD42022326944). Papers available by March 2023 assessing exercise interventions in psychotic patients were included. A significant improvement was found in Positive and Negative Syndrome Scale (PANSS) positive symptoms (MD = -0.75 [-1.35, -0.15], p = 0.01), with large effect sizes for PANSS-negative and general symptoms (-2.14 [-3.36, -0.92]) and (-2.53 [-3.15, -1.91]), respectively. Heterogeneity was high among studies, 49 and 73% for PANSS-positive and negative symptoms, and low, 0%, for general symptoms. It was hypothesized that functioning of specific brain areas, such as the temporal lobe and hippocampus, may underlie the improvement seen with exercise. Based on neuroimaging/neurophysiology studies, we propose a neurobiological model accounting for the association between exercise and psychotic symptom improvement.

Dietary intake, physical activity and sedentary behaviour patterns in a sample with established psychosis and associations with mental health symptomatology

BACKGROUND

People with psychosis experience cardiometabolic comorbidities, including metabolic syndrome, coronary heart disease and diabetes. These physical comorbidities have been linked to diet, inactivity and the effects of the illness itself, including disorganisation, impairments in global function and amotivation associated with negative symptoms of schizophrenia or co-morbid depression.

METHODS

We aimed to describe the dietary intake, physical activity (PA) and sedentary behaviour patterns of a sample of patients with established psychosis participating in the Improving Physical Health and Reducing Substance Use in Severe Mental Illness (IMPaCT) randomised controlled trial, and to explore the relationship between these lifestyle factors and mental health symptomatology.

RESULTS

A majority of participants had poor dietary quality, low in fruit and vegetables and high in discretionary foods. Only 29.3% completed ⩾150 min of moderate and/or vigorous activity per week and 72.2% spent ⩾6 h per day sitting. Cross-sectional associations between negative symptoms, global function, and PA and sedentary behaviour were observed. Additionally, those with more negative symptoms receiving IMPaCT therapy had fewer positive changes in PA from baseline to 12-month follow-up than those with fewer negative symptoms at baseline.

CONCLUSION

These results highlight the need for the development of multidisciplinary lifestyle and exercise interventions to target eating habits, PA and sedentary behaviour, and the need for further research on how to adapt lifestyle interventions to baseline mental status. Negative symptoms in particular may reduce patient's responses to lifestyle interventions.

A single-blind, randomised controlled trial of a physical health nurse intervention to prevent weight gain and metabolic complications in first-episode psychosis: the Physical Health Assistance in Early Psychosis (PHAstER) study

BACKGROUND

Factors that contribute to the early mortality observed in psychotic disorders, specifically obesity, smoking and sedentary behaviour, occur early in the disorder.

AIMS

We aimed to determine whether the integration of a physical health nurse in the care of young people with first-episode psychosis could prevent clinically significant weight gain (≥7% body weight). Secondary outcomes included rates of smoking, metabolic syndrome and sedentary behaviour.

METHOD

In this single-blind, randomised controlled trial, participants who had received under 4 weeks of antipsychotic medication were randomly allocated to either the intervention (addition of a physical health nurse to their care) or treatment as usual (TAU) for 12 weeks.

RESULTS

Of the 77 participants, there were follow-up data for 86.8% (n = 33) of the intervention group and 82.1% (n = 32) of the TAU group. After 12 weeks, 27.3% of the intervention group experienced clinically significant weight gain compared with 34.4% of the TAU group (odds ratio 0.72, 95% CI 0.25-2.06, P = 0.54). After 6 months, 40.7% of the intervention group gained clinically significant weight compared with 44.1% of the TAU group (P = 0.79). There was no difference in mean change in weight between groups after 12 weeks (2.6 kg v. 2.9 kg, P = 0.87) or 6 months (3.6 kg v. 4.3 kg, P = 0.64). There were no differences in the rates of tobacco smoking cessation, prevalence of metabolic syndrome or physical activity levels.

CONCLUSIONS

This intervention failed to prevent the metabolic complications that are highly prevalent in psychotic disorders in the short to medium term, indicating that more intensive interventions are required.

Motivational coaching augmentation of exercise intervention for early psychotic disorders: A randomised controlled trial

BACKGROUND

Exercise offers improvement to physical and mental health symptoms as well and cognitive function in patients with psychosis. However, patients with psychosis are often less ready to benefit from exercise intervention because of the difficulties in motivation. This study aimed to examine the effectiveness of adjunctive motivational coaching on exercise intervention in women with psychosis in Hong Kong.

METHODS

From a community mental health programme for women, patients with a diagnosis of psychotic disorder (within 5 years of first onset) were randomly allocated to receive 12 30-minute sessions of motivational coaching or psychoeducation in a group format. Both groups additionally received exercise intervention sessions consisting of yoga, stretching and high-intensity interval training. Primary outcome was the total physical activity level measured by the International Physical Activity Questionnaire.

RESULTS

Fifty-seven patients (mean [SD] age, 34.47 [12.44] years) were randomised into motivational coaching (n = 30) or psychoeducation (n = 27) treatment groups. The motivational coaching group had a significantly higher total physical activity level (4601.67 [686.59] vs 2524.82 [723.73] metabolic equivalent task-min/week, r² = 0.473, p = 0.04) after the intervention and at 6 months post-intervention. Moderate and light physical activity levels were significantly higher in the motivational coaching group after intervention and at 6 months, respectively. Additionally, symptoms of bizarre behaviour were improved in the motivational coaching group at 6 months. Younger, unemployed, unmarried and those with longer durations of untreated psychosis generally showed larger improvements in the motivational coaching group.

CONCLUSION

Motivational coaching may augment the effects of exercise interventions, as reflected by higher physical activity participation. Motivational coaching augmentation has the potential to further improve exercise intervention outcomes.

Physical Health Impairment and Exercise as Medicine in Severe Mental Disorders: A Narrative Review

BACKGROUND

Individuals with severe mental disorders (SMDs; schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder) are not only suffering from their mental conditions; they also have an attenuated physical health, augmenting their overall critical condition.

OBJECTIVES

We review and critically appraise the evidence based on (1) key physiological factors relating to aerobic endurance and skeletal muscle strength; (2) implications for physical function and health; and (3) effects of training interventions with different intensities evaluated in individuals with SMDs.

FINDINGS

Reductions in aerobic endurance factors, peak oxygen uptake (VO_2peak) and walking work efficiency, are paralleled by reductions in maximal skeletal muscle strength and power. In turn, the poor aerobic endurance and muscle strength lead to impaired physical function, increased risk of lifestyle-related diseases, and ultimately early death. Exercise has the potential to counteract the attenuated physical health in people with SMDs. While aerobic endurance training is shown to increase VO_2peak due to plasticity of the oxygen transport system, strength training is documented to improve maximal muscle strength, power, and walking work efficiency as a result of adaptations in neuromuscular force developing factors.

CONCLUSIONS

In conclusion, improvements in these key determinants for physical health appear to be achievable in people with SMDs despite many being challenged by motivational difficulties with attending regular exercise and have beneficial implications for physical function during activities of daily living, lifestyle-related diseases, and early death.

Physical Activity, Positive and Negative Symptoms of Psychosis, and General Psychopathology among People with Psychotic Disorders: A Meta-Analysis

Objective: Existing reviews provided evidence for the associations between higher physical activity (PA) and lower negative symptoms of psychosis among people with schizophrenia. This meta-analysis goes beyond existing syntheses and investigates associations between PA, positive and negative symptoms of psychosis, as well as symptoms of general psychopathology (referring mostly to cognitive functioning) among people with schizophrenia, but also other psychotic disorders. The moderating roles of the type of diagnosis and the type of exercise intervention were explored. Methods: The study was registered with PROSPERO (CRD42018118236). Six electronic databases were searched; n = 27 experimental and observational studies were included, and psychotic symptoms-related data were recorded in one direction (higher values indicate better mental health and lower symptomatology). Results: Higher levels of PA (or participating in PA interventions) were associated with better mental health, that is, lower levels of positive symptoms (all studies: r = 0.170; experimental studies: SMD = 0.677), negative symptoms (all studies: r = 0.214; experimental studies: SMD = 0.838), and general psychopathology (all studies: r = 0.451; experimental studies: SMD = 1.511). The type of diagnosis (schizophrenia vs. other psychotic disorders) did not moderate these associations. Conclusions: We found a consistent pattern of associations between higher levels of PA and lower positive, negative, and general psychopathology symptoms in people with schizophrenia and those with other psychotic disorders.

Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine

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.

High-intensity interval training may reduce depressive symptoms in individuals with schizophrenia, putatively through improved VO2max: A randomized controlled trial

INTRODUCTION

High-intensity interval training (HIIT) may improve cardiorespiratory fitness (CRF) and mental health. The current observer-blinded RCT investigates the sparsely studied efficiency of HIIT in reducing psychotic and non-psychotic symptoms in schizophrenia and complements previous studies by investigating whether symptom reduction following HIIT is associated with, putatively partly mediated by, increased VO₂max.

METHODS

Participants (outpatients meeting diagnostic criteria for schizophrenia) were randomized to HIIT (n = 43) or a comparison group performing low-intensity active video gaming (AVG) to control for social interaction (n = 39). Both interventions consisted of two supervised sessions/week for 12 weeks and a 4 months follow-up. Effects on overall symptoms and symptom domains [PANSS (0-6 scale), five-factor model] were estimated using mixed-effects models (intention-to-treat, n = 82). Underlying mechanisms were analyzed using moderated mediation analyses (n = 66). We anticipated that HIIT would reduce overall symptoms, particularly depressive symptoms, more than AVG, and symptom reduction would be associated with, putatively mediated through, improved VO₂max.

RESULTS

Depressive symptoms (baseline score 3.97, 95% CI: 3.41, 4.52), were -1.03 points more reduced in HIIT than AVG at post-intervention (95% CI: -1.71, -0.35, p = 0.003), corresponding to a small to moderate effect size (d = 0.37) and persisting at follow-up. There was a small reduction in overall symptoms, but no significant between-group differences were observed. Change in VO₂max correlated negatively with the change in depressive symptoms. Mediation analysis showed a significant effect of change in VO₂max on change in depressive symptoms within HIIT. The total effect was moderated by group, and depressive symptoms were more reduced in HIIT. Direct effects, not mediated through VO₂max, were non-significant. Indirect effects, mediated through VO₂max, were non-significant, but the moderated mediation test indicated a non-significant trend of 0.4 points (95% CI: -1.188, 0.087) and a larger reduction in depressive symptoms through VO₂max in HIIT.

CONCLUSION

HIIT reduced depressive symptoms more than AVG, which persisted at follow-up. HIIT may serve as a complementing treatment option targeting these symptoms in individuals with schizophrenia, even before they reach clinical depression. Depressive symptoms are important to prevent, stabilize, and treat due to their negative implications for psychological wellbeing and long-term functional outcome. Reduction in depressive symptoms was associated with improved VO₂max, and non-significant trends in the data supported that improved VO₂max may be part of the complex mechanisms underlying the anti-depressive effect of HIIT.

CLINICAL TRIAL REGISTRATION

[www.ClinicalTrials.gov], identifier [NCT02205684].

Study protocol for a pilot high-intensity interval training intervention in inpatient mental health settings: a two-part study using a randomised controlled trial and naturalistic study design

BACKGROUND

Severe mental illnesses (SMI), including schizophrenia spectrum disorder, bipolar disorder and major depressive disorder, are associated with physical health comorbidities and premature mortality. Physical activity and structured exercise have a beneficial impact on cardiometabolic risk and ameliorate mental health symptomology and cognition. This protocol describes a feasibility study for a high-intensity interval training (HIIT) intervention among inpatients with SMI, to improve their physical and mental health.

METHODS

The feasibility study follows a two-part design owing to COVID-19-related adaptations to project design: (a) a non-blinded randomised controlled trial (RCT) of 12 weeks of bicycle-based HIIT, delivered twice weekly in a face-to-face, one-to-one setting, compared to treatment as usual (TAU) and (b) a naturalistic study of inpatient HIIT; eligible participants will be invited to two sessions of HIIT per week, delivered by the research team remotely or in person. Additionally, participants in the naturalistic study may use the bike to conduct self-directed sessions of their chosen length and intensity. We will measure the feasibility and acceptability of the HIIT intervention as primary outcomes, alongside secondary and tertiary outcomes evaluating the physical, mental and cognitive effects of HIIT. The study aims to recruit 40 patients to the RCT and 6-8 patients to the naturalistic design.

DISCUSSION

Exercise is a modifiable lifestyle barrier that can reverse cardiometabolic disease risk. If HIIT is found to be feasible and acceptable in inpatients with SMI, there would be scope for large-scale work to evaluate the clinical, cost and implementation effectiveness of HIIT in inpatient mental health settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03959735 . Registered June 22, 2019.

Cognitive effectiveness of high-intensity interval training for individuals with methamphetamine dependence: a study protocol for randomised controlled trial

INTRODUCTION

Cognitive deficit is a common syndrome of methamphetamine (MA) dependence. It is related to decision-making, control ability, and social functioning. High-intensity interval training (HIIT) is a training technique that requires people to work out at full intensity during a short period. Many studies have already shown the potential effects of HIIT on cognitive functions. The purpose of this trial is to evaluate the cognitive effects of HIIT on individuals with MA dependence.

METHODS AND ANALYSIS

A total of 240 individuals with MA dependence will be randomly assigned to the HIIT group, moderate-intensity continuous training (MICT) group and control (CON) group. HIIT will consist of a 24-min HIIT exercise on a treadmill. MICT will consist of a 1-h body-mind exercise. CON will be their traditional intervention. The experimental period will be 12 months with 3 interventions weekly for the first 6 months and follow-up for the next 6 months. All subjects will be given cognitive tests at baseline, after intervention and at follow-up. Cognitive performances will be compared by a mixed-model analysis for repeated measures.

DISCUSSION

HIIT training may reduce illicit drug cravings amongst individuals with MA dependence; hence, HIIT may have a good effect on the cognitive functions, such as memory and executive function, of individuals with MA dependence.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000032492 . Registered on April 30, 2020 ( http://www.chictr.org.cn/edit.aspx?pid=52127&htm=4 ).

Short Term, Oral Supplementation with Optimized Curcumin Does Not Impair Performance Improvements Associated with High Intensity Interval Training

Curcumin may improve athletic performance through a reduction in inflammation following exercise and improve mental states of well-being. The purpose of this investigation was to explore the effects of a 14 day HIIT intervention and oral supplementation with Longvida^® optimized curcumin on athletic performance, lactate response, and well-being. Sixteen males and twenty females participated in a double-blinded, randomized, placebo-controlled trial to explore the effects of Longvida(R) optimized curcumin (1.0 g/day) and or a placebo (PLA) taken daily during a 14 day HIIT protocol. Participants were randomized into two groups, then evaluated in three groups, curcumin-fast (CURF), curcumin-slow (CURS) and placebo. Curcumin-fast and curcumin-slow were separated by their 16.1 km cycling time trial performance (TT) with CURF and CURS determined by a TT <30 min and >30 min at the pre intervention time point, respectively. Cycling time-trial performance, blood lactate response, and well-being assessments were determined at pre and post 14 day HIIT intervention time points. Blood lactate was recorded at baseline, 8.01 km, 15.1 km, and 1 min post, and 4 min post of the pre and post intervention TT. Following the internvetion, CONP and CURS experienced with 8.15% and 5.04% improvements in TT performance times, while CURF experienced a 0.57% improvement in TT performance time. No changes were observed with respect to other measures. When curcumin is taken daily in conjunction with 14 days of HIIT on a cycle ergometer, cycling performance in either well trained or more recreationally trained athletes is not impaired. Although the improvements in TT performance were not stasticially significant, they are noteworthy.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

One-year aerobic interval training in outpatients with schizophrenia: A randomized controlled trial

Although aerobic interval training (AIT) is recognized to attenuate the risk of cardiovascular disease (CVD) and premature mortality, it appears that it rarely arrives at patients' doorsteps. Thus, this study investigated 1-year effects and feasibility of AIT delivered with adherence support in collaborative care of outpatients with schizophrenia. Forty-eight outpatients (28 men, 35 [31-38] (mean [95% confidence intervals]) years; 20 women, 36 [30-41] years) with schizophrenia spectrum disorders (ICD-10) were randomized to either a collaborative care group provided with municipal transportation service and training supervision (walking/running 4 × 4 minutes at ~90% of peak heart rate; HR_peak ) 2 d wk^-1 at the clinic (TG) or a control group (CG) given 2 introductory AIT sessions and advised to continue training. Directly assessed peak oxygen uptake ( V ˙ O 2 peak ) increased in the TG after 3 months (2.3 [0.6-4.4] mL kg^-1  min^-1 , Cohen's d = 0.33[-4.63 to 4.30], P = 0.04), 6 months (2.7 [0.5-4.8] mL kg^-1  min^-1 , Cohen's d = 0.42[-4.73 to 4.11], P = 0.02) and 1 year (4.6 [2.3-6.8] mL kg^-1  min^-1 , Cohen's d = 0.70[-4.31 to 4.10], P < 0.001) compared to the CG. One-year cardiac effects revealed higher HR_peak (7 [2-11] b min^-1 , Cohen's d = 0.34[-8.48 to 8.65], P = 0.01), while peak stroke volume tended to be higher (0.9 [-0.2 to 2.0] mL b^-1 , Cohen's d = 0.35[-1.62 to 2.01], P = 0.11) in the TG compared to the CG. Conventional risk factors (body weight, waist circumference, blood pressure, and lipids/glucose) remained unaltered in both groups. One-year AIT adherence rates were 15/25 (TG; different from CG: P < 0.001) and 0/23 (CG). AIT was successfully included in long-term collaborative care of outpatients with schizophrenia and yielded improved V ˙ O 2 peak , advocating this model for aerobic capacity improvement and CVD risk reduction in future treatment.

Resistance training in patients with schizophrenia: Concept and proof of principle trial

Resistance training has been shown to contribute to the prevention and management of cardiovascular diseases, which is why it can help reducing morbidity and mortality in schizophrenia patients. Moreover, positive effects on different schizophrenia symptom domains have been proposed. However, a specific resistance training tailored to the needs of schizophrenia patients and its evaluation is still lacking. The objective in this proof of principle trial was to evaluate the feasibility and efficacy of a newly developed 12-week resistance program according to current recommendations of the WHO and the American College of Sports Medicine. We employed a single blind, parallel assignment clinical trial design with participants randomized to attend either a resistance training including three 50min units per week or a balance and tone program as control condition. The primary outcome was the impact on health-related difficulties assessed with the World Health Organization Disability Assessment Schedule (WHO-DAS). Secondary outcome parameters included the level of functioning, schizophrenia symptoms, selected cognitive parameters as well as risk factors for cardiovascular diseases. In our proof of principle trial, we could not find significant time or group effects of resistance training on the WHO-DAS. However, we could observe significant positive effects on the level of functioning assessed with the Global Assessment of Functioning Scale (GAF) over the course of time, which were more pronounced in the intervention group. Our findings indicated that patients with schizophrenia could safely participate in resistance training with relevant improvements in their level of functioning. Well-powered replication trials are needed to provide more efficacy data.