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Rißmayer M, Kambeitz J, Javelle F, Lichtenstein TK. 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. Schizophr Bull 2024; 50:615-630. [PMID: 38394386 DOI: 10.1093/schbul/sbae015] [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: 02/25/2024]
Abstract
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.
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Affiliation(s)
- Matthias Rißmayer
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, NeuroPsychoImmunology Research Unit, German Sport University Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Javelle
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, NeuroPsychoImmunology Research Unit, German Sport University Cologne, Cologne, Germany
| | - Theresa Katharina Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Chang KT, Goh KK, Latthirun K, Yang CT. The effect of exercise on cognition and clinical symptoms of patients with schizophrenia: A systematic review of randomized controlled trial. PROGRESS IN BRAIN RESEARCH 2024; 283:255-304. [PMID: 38538191 DOI: 10.1016/bs.pbr.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Physical activity has been viewed as a potential non-pharmacological therapeutic strategy to improve the clinical symptoms and neurocognitive deficits in patients with schizophrenia. However, there are various types of physical activities, and different exercise prescriptions might produce inconsistent benefits. Thus, this study aimed to conduct a systematic review of exercise interventions for patients with schizophrenia, clarifying the benefits of these interventions on cognitive function and clinical symptoms. This review encompasses six electronic databases, with inclusion criteria including randomized controlled trial designs, participants with schizophrenia, and a comprehensive exercise intervention program. Twenty-seven studies met the inclusion criteria, incorporating data from 1549 patients with schizophrenia. The results highlight that when comparing the exercise intervention group to the non-intervention control group, patients with schizophrenia showed significant improvement in negative symptoms. Structured exercise interventions can help improve the negative symptoms of schizophrenia, filling the gaps where medication falls short. Regarding functional outcomes, exercise interventions aid in enhancing the overall functionality (psychological, social, occupational) of individuals with schizophrenia. The improvement is largely tied to the boost in physical fitness that exercise provides. Based on current findings, exercise interventions assist in enhancing cognitive function in patients with schizophrenia. Notably, significant improvements are observed in higher-order cognitive functions, including processing speed, attention, and working memory. It is recommended to engage in moderate-intensity exercises at least three times a week, with each session lasting a minimum of 30min. Well-structured exercise interventions contribute to enhancing the negative symptoms and cognitive functions in patients with schizophrenia.
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Affiliation(s)
- Kun-Tang Chang
- International Doctoral Program in Principles and Implications of Mind Science, National Cheng Kung University, Tainan, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Kanthika Latthirun
- International Doctoral Program in Principles and Implications of Mind Science, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Ta Yang
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan; Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan.
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Vila-Barrios L, Carballeira E, Varela-Sanz A, Iglesias-Soler E, Dopico-Calvo X. The Impact of Regular Physical Exercise on Psychopathology, Cognition, and Quality of Life in Patients Diagnosed with Schizophrenia: A Scoping Review. Behav Sci (Basel) 2023; 13:959. [PMID: 38131815 PMCID: PMC10740550 DOI: 10.3390/bs13120959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
The presence of less healthy lifestyle habits among individuals diagnosed with schizophrenia which can contribute to the escalation of physical disorders and exacerbation of psychological symptoms is well documented. The present scoping review aims to synthesize and evaluate the available evidence regarding the impact of regular physical exercise on psychopathology, cognition, and quality of life (QoL) in patients diagnosed with schizophrenia. A literature search was performed across Web of Science, SCOPUS, PubMed, and SPORTDiscus for randomized control trials published up to April 2022. Two independent reviewers applied the selection criteria and a third reviewer resolved discrepancies. A total of twelve studies were included, of which nine used endurance training and three used concurrent training (one of these additionally used resistance training). The results reveal benefits of various modalities of supervised regular exercise in the psychopathology of schizophrenia. Furthermore, regular endurance training seems to improve cognitive function in patients with schizophrenia and promote their QoL; however, results are inconclusive with respect to this last variable. The assessment of methodological quality in the reviewed articles indicates a high overall risk of bias, particularly in relation to deviations from intended interventions and the selection of reported results. Furthermore, an assessment of exercise reporting revealed that only 5 out of 19 items were fulfilled in more than 50% of the articles. Future research is needed to evaluate the effects of different training modalities and the optimal dose-response relationship in patients diagnosed with schizophrenia.
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Affiliation(s)
| | - Eduardo Carballeira
- Performance and Health Group, Department of Physical Education and Sport, University of A Coruna, 15179 A Coruña, Spain; (L.V.-B.); (A.V.-S.); (E.I.-S.); (X.D.-C.)
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Wazni L, Gifford W, Perron A, Vandyk A. Understanding the Physical Health Problems of People with Psychotic Disorders Using Digital Storytelling. Issues Ment Health Nurs 2023; 44:690-701. [PMID: 37549316 DOI: 10.1080/01612840.2023.2229435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
People with psychotic disorders struggle to be heard and express concerns beyond their mental health, especially concerns related to the side effects of treatment. Using digital storytelling, this study aimed to uncover and expose the underlying systems that oppress people with psychotic disorders from meeting their physical health needs. The stories revealed two themes: body as a contested site and biological entity with society, and (in)visible patient and paternalism. Spivak's theory of subalternity provided the theoretical basis for a critical analysis and discussion of the experiences. More research is required to highlight the power relations and structures that lead to health disparity in psychiatry.
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Affiliation(s)
- Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amélie Perron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Korman N, Stanton R, Vecchio A, Chapman J, Parker S, Martland R, Siskind D, Firth J. The effect of exercise on global, social, daily living and occupational functioning in people living with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2023; 256:98-111. [PMID: 37209456 DOI: 10.1016/j.schres.2023.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
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.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Anna Vecchio
- Addiction and Mental Health Services, Metro South Health Services, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Australia; Queensland Institute of Medical Research, Brisbane, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Metro North Mental Health Services, Australia
| | - Rebecca Martland
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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