Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality

Abstract

Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.

Identification of gut microbiome markers for schizophrenia delineates a potential role of Streptococcus

“…Gut microbes enriched in both schizophrenia and metabolic disorders/cardiovascular disease may account for the increased risk of these comorbidities in schizophrenia. Moreover, new evidence also indicates that metabolic disorders in schizophrenia are not only comorbidities, but also affect pathogenesis, such as the manifestation of negative symptoms 62 , cognitive function 63 , and brain white matter disruption 64 . Treating metabolic disorders via physical activity and psychosocial and dietary interventions, is also an effective approach to improve the symptoms of schizophrenia 63 .…”

Effects of physical activity on treatmentof schizophrenia

“…Negative effects of schizophrenia on daily functioning and subjective well-being have been well Archives of Psychiatry and Psychotherapy, 2019; 1: [28][29][30][31][32][33][34][35] documented [4]. Among some of its other characteristics remain reduced physical activity, poor physical health, and limited daily activity [5].…”

“…The metabolic syndrome (ie. increased waist circumference combined with low HDL cholesterol, high blood pressure, elevated triglycerides and fasting glucose levels), which is linked with a 4-fold increased risk of type 2 diabetes and a 2-fold risk of CVD (such as stroke and coronary heart disease) [16] in the general population, has a 4 times higher prevalence in schizophrenia patients [4], leading to a 2-3-fold higher risk of CVD, and thus also increased cardiac mortality [17]. Such data are consistent with findings reporting elevated risk of the metabolic syndrome (MS) in all patients with SMI [17].…”

“…An alternative to aerobic exercise, expected to potentially increase its somewhat insufficient efficacy is high-intensity interval training (HIIT), ie. a new form of intensified endurance activity [4], considered a time-efficient method to improve body composition [47]. There is good evidence that in mentally healthy populations with obesity and cardiometabolic risk factors, this type of intervention can elicit stronger beneficial effects on metabolic parameters, including waist circumference, body mass, HDL cholesterol, fasting glucose and blood pressure [48].…”

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

“…Increasing physical activity by aerobic exercise programs may improve metabolic syndrome and cardiovascular risk factors in patients with mental disorders, thus improving mortality [2]. A new meta-analysis [3] reveals that SZ patients have lower vigorous physical activity, and this variable correlates with disease-specific factors of social functioning such as withdrawal, low independence performance, employment and motivation/energy. For a long time, specific mechanisms of aerobic exercise-mediating effects on the pathophysiology of mental disorders were unknown.…”