Aerobic exercise in mental disorders: from basic mechanisms to treatment recommendations

Schmitt, Aurore; Reich‐Erkelenz, Daniela; Hasan, Alkomiet; Falkai, Peter

doi:10.1007/s00406-019-01037-6

Cited by 13 publications

(9 citation statements)

References 10 publications

(10 reference statements)

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“…Another meta-analysis of 29 trials on the overall effects of exercise in patients with schizophrenia [ 9 ] found that exercise was superior to the control conditions in improving total symptom severity ( g = 0.39, p < 0.001); positive ( g = 0.32, p < 0.01), negative ( g = 0.49, p < 0.001), and general symptoms ( g = 0.27, p < 0.05); quality of life ( g = 0.55, p < 0.001); global functioning ( g = 0.32, p < 0.01); and depressive symptoms ( g = 0.71, p < 0.001). However, study designs, diagnostic procedures, and outcome variables have varied widely in previous exercise studies in patients with schizophrenia [ 32 , 33 ] and, so far, no multicenter randomized controlled trials have been conducted. The frequent lack of exact training parameters, a control group, a randomization procedure, or an adequately large sample size are the further shortcomings.…”

Section: Introductionmentioning

confidence: 99%

Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial

Maurus

Hasan

Schmitt

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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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).

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Section: Introductionmentioning

confidence: 99%

Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial

Maurus

Hasan

Schmitt

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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Section: Improvements Of Crf In Patients With Severe Mental Illnessmentioning

confidence: 99%

“…It stimulates synaptic and brain plasticity and affects the volume of specific brain regions, with genetic risk (SZ-PRS) influencing the results. However, despite the growing body of literature, the type, duration, and frequency of exercise needed for beneficial effects in the long term have yet to be determined before aerobic exercise will be used widely in general practice [ 109 ]. Some recommendations for further studies can be given from the perspective of sports medicine: The American College of Sports Medicine recommends that adults engage in moderate-intensity cardiorespiratory exercise training for ≥ 30 min/day on ≥ 5 days/week for a total of ≥ 150 min/week, or vigorous-intensity cardiorespiratory exercise training for ≥ 20 min/day on ≥ 3 days/week for a total of ≥ 75 min/week [ 110 ].…”

Section: Introductionmentioning

confidence: 99%

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

Falkai

Schmitt

Rosenbeiger

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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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.

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“…In particular, exercise interventions aiming at enhancing aerobic fitness represent promising adjunctive treatment strategies in schizophrenia [19,23,27,29].…”

Section: Introductionmentioning

confidence: 99%

Association between aerobic fitness and the functional connectome in patients with schizophrenia

Roell¹

2021

Preprint

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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. 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. 58 patients with schizophrenia were included in the 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 a mediation analysis. Static functional connectivity between the subcortical nuclei and the cerebellum as well as between temporal seeds mediated the attenuating impact of aerobic fitness on 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 relation between aerobic fitness and emotion recognition. 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 results have to be interpreted carefully. Further interventional aerobic exercise studies are needed in order to replicate the current findings and to enable conclusive causal inferences.

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Aerobic exercise in mental disorders: from basic mechanisms to treatment recommendations

Cited by 13 publications

References 10 publications

Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial

Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial

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

Association between aerobic fitness and the functional connectome in patients with schizophrenia

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