Adjunctive exercise interventions beneficial in schizophrenia treatment

The combination of aerobic exercise interventions plus conventional treatment works better than conventional treatment alone in terms of alleviating symptoms of schizophrenia, especially negative symptoms, according to the results of a network meta-analysis.

Pooled data from 17 studies involving 973 patients with schizophrenia showed that compared with other forms of adjunctive interventions, aerobic exercise interventions produced the greatest reductions in the Positive and Negative Symptom Scale (PANSS) total score (mean difference [MD], −4.84, 95 percent confidence interval [CI], −5.72 to −3.96). [Schizophr 2024;doi:10.1038/s41537-023-00426-0]

Specifically, adjunctive aerobic exercise interventions had a pronounced effect on negative symptoms, as measured by either the PANSS negative symptom subscale (MD, −2.11, 95 percent CI, −3.26 to −0.95) or Scale for Assessment of Negative Symptoms (SANS; MD, −9.11, 95 percent CI, −11.94 to −6.27).

“Currently, the standard approach to treating schizophrenia predominantly relies on [conventional therapy], which encompasses antipsychotic medication, psychiatric disorder education, medication usage guidance, and advice on daily life precautions,” the investigators noted. “While timely and accurate medication administration effectively ameliorates the positive symptoms of schizophrenia, [conventional therapy] has limited efficacy in improving negative symptoms.”

The present findings are encouraging, since it is crucial to ameliorate negative symptoms to facilitate the reintegration of patients into normal life, according to the investigators.

Low bias risk

All 17 studies included in the meta-analysis were assessed as ‘low risk’ in the areas of randomization process, deviations from intended interventions, missing outcome data, and measurement of the outcome. Six studies were deemed to have ‘some concerns’ in the domain of selection of the reported result, which led to the overall quality assessment having the rating of ‘some concerns’.

Of the studies included, 12 reported PANSS scores, five reported SANS scores, and three reported body mass index (BMI) values. The patient population included adults treated as inpatients and outpatients. The duration of the exercise interventions ranged from 1 month to 12 months. 

“[O]ur analysis on BMI revealed no significant effect of aerobic exercise, which aligns with the conclusions drawn [in a previous study], suggesting that weight management may not be an immediate outcome of exercise interventions in this population,” the investigators said. [Psychol Med 2015;45:1343-1361]

In a subgroup meta-analysis, interventions with 100–220 minutes per week of exercise that lasted 2–3 months yielded the greatest benefits. Additionally, adherence to the adjunctive aerobic exercise regimen was relatively high.

High adherence

An interesting finding was that adherence rate for adjunctive exercise interventions did not significantly differ with that for conventional treatment alone (85.6 percent vs 84.6 percent, respectively).

According to the investigators, there are several reasons why patients stick with their exercise programs as an add-on therapy.

For the most part, exercise in both group and individual settings provides a platform for social interaction, which can encourage patients to connect and improve their communication and social skills, the investigators pointed out. They added that many interventions incorporate strategies such as phone check-ins and online exercise logs, both of which can create a stronger link between patients and healthcare providers, potentially improving communication and adherence.

“Lastly, the flexibility to choose the type of exercise in these interventions may promote personalization of treatment plans, thus facilitating better adherence to the regimen,” they continued.

“The type of aerobic exercise can be tailored to the individual’s preferences, with low-to-moderate intensity options such as yoga, slow walking, jogging, gymnastics, and table tennis being recommended. The optimal duration for the intervention is between 2 and 3 months, with an advisable frequency of 3–5 exercise sessions per week, each lasting 35–45 minutes,” the investigators said.