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European Archives of Psychiatry and Clinical Neuroscience

19-03-2024 | Schizophrenia | Original Paper

The impact of aerobic endurance training on cognitive performance in schizophrenic inpatients in a clinical routine setting

Authors: Elisa Semler, Florian Herpich, Leonhard Zellner, Sarah Zwick, Peter Zwanzger, Alexander Brunnauer

Published in: European Archives of Psychiatry and Clinical Neuroscience

Abstract

The primary aim of this study was to investigate the impact of aerobic endurance training in schizophrenic inpatients on cognitive performance in a clinical routine setting. Of secondary interest was the influence on psychopathological symptoms. A total of 31 schizophrenic inpatients were randomly assigned to receive either controlled endurance training or occupational therapy. The experimental group underwent endurance training of 20–30 min each, 3 times per week for a total of up to 22 training sessions. The control group received about 90 min of occupational therapy, 2–3 times per week for up to 22 sessions. Cognitive performance was assessed via an extensive neuropsychological examination before randomization and prior to discharge. Significant improvements in cognitive functions and psychopathology could be shown in both groups. For verbal memory functions (short-term memory, working memory, and learning performance), there was a significant advantage for the aerobic endurance training group. Physical exercise is a feasible, easy-to-implement add-on therapy for schizophrenic patients in a clinical routine setting with positive effects on verbal memory functions. Besides, it seems important to fill the gap between inpatient and outpatient health care, providing physical training supply for this patient group.

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Zielasek J, Hasan A, Gaebel W (2019) Diagnose und Differenzialdiagnose, Verlauf und Prognose. In: Falkai P, Hasan A (eds) Praxishandbuch Schizophrenie, 2nd edn. Elsevier, München, pp 71–93

Palmer BW, Heaton RK, Paulsen JS, Kuck J, Braff D, Harris MJ, Zisook S, Jeste DV (1997) Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 11(3):437–446. https://doi.org/10.1037/0894-4105.11.3.437CrossRefPubMed

Zanelli J, Reichenberg A, Morgan K, Fearon P, Kravariti E, Dazzan P, Morgan C, Zanelli C, Demjaha A, Jones PB, Doody GA, Kapur S, Murray RM (2010) Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations. Am J Psychiatry 167(1):78–85. https://doi.org/10.1176/appi.ajp.2009.09010118CrossRefPubMed

Keefe RSE, Bilder RM, Davis SM, Harvey PD, Palmer BW, Gold JM, Meltzer HY, Green MF, Capuano G, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Davis CE, Hsiao JK, Lieberman JA (2007) Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE Trial. Arch Gen Psychiatry 64(6):633–647. https://doi.org/10.1001/archpsyc.64.6.633CrossRefPubMed

Green MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? AJP 153(3):321–330. https://doi.org/10.1176/ajp.153.3.321CrossRef

Knapp M, Mangalore R, Simon J (2004) The global costs of schizophrenia. Schizophr Bull 30(2):279–293. https://doi.org/10.1093/oxfordjournals.schbul.a007078CrossRefPubMed

Chang X, Shen H, Wang L, Liu Z, Xin W, Hu D, Miao D (2014) Altered default mode and fronto-parietal network subsystems in patients with schizophrenia and their unaffected siblings. Brain Res 1562:87–99. https://doi.org/10.1016/j.brainres.2014.03.024CrossRefPubMed

Dauwan M, Begemann MJH, Slot MIE, Lee EHM, Scheltens P, Sommer IEC (2021) Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. J Neurol 268(4):1222–1246. https://doi.org/10.1007/s00415-019-09493-9CrossRefPubMed

Etnier JL, Salazar W, Landers DM, Petruzzello SJ, Han M, Nowell P (1997) The influence of physical fitness and exercise upon cognitive functioning: a meta-analysis. J Sport Exerc Psychol 19(3):249–277. https://doi.org/10.1123/jsep.19.3.249CrossRef

10.

Maurus I, Hasan A, Schmitt A, Roeh A, Keeser D, Malchow B, Schneider-Axmann T, Hellmich M, Schmied S, Lembeck M, Keller-Varady K, Papazova I, Hirjak D, Topor CE, Walter H, Mohnke S, Vogel BO, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P (2021) Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 271(2):315–324. https://doi.org/10.1007/s00406-020-01175-2CrossRefPubMed

11.

Maurus I, Hasan A, Röh A, Takahashi S, Rauchmann B, Keeser D, Malchow B, Schmitt A, Falkai P (2019) Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 269(5):499–515. https://doi.org/10.1007/s00406-019-01025-wCrossRefPubMed

12.

Organization WHO (2019) Global action plan on physical activity 2018–2030. More active people for a healthier world. World Health Organization, Geneva

13.

Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N (2017) Dementia prevention, intervention, and care. Lancet (London, England) 390(10113):2673–2734. https://doi.org/10.1016/S0140-6736(17)31363-6CrossRefPubMed

14.

Buschert V, Prochazka D, Bartl H, Diemer J, Malchow B, Zwanzger P, Brunnauer A (2019) Effects of physical activity on cognitive performance: a controlled clinical study in depressive patients. Eur Arch Psychiatry Clin Neurosci 269(5):555–563. https://doi.org/10.1007/s00406-018-0916-0CrossRefPubMed

15.

Eriksson S, Gard G (2011) Physical exercise and depression. Phys Therapy Rev 16(4):261–268. https://doi.org/10.1179/1743288X11Y.0000000026CrossRef

16.

Knöchel C, Oertel-Knöchel V, O’Dwyer L, Prvulovic D, Alves G, Kollmann B, Hampel H (2012) Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol 96(1):46–68. https://doi.org/10.1016/j.pneurobio.2011.11.007CrossRefPubMed

17.

Kvam S, Kleppe CL, Nordhus IH, Hovland A (2016) Exercise as a treatment for depression: a meta-analysis. J Affect Disord 202:67–86. https://doi.org/10.1016/j.jad.2016.03.063CrossRefPubMed

18.

Neviani F, Belvederi Murri M, Mussi C, Triolo F, Toni G, Simoncini E, Tripi F, Menchetti M, Ferrari S, Ceresini G, Cremonini A, Bertolotti M, Neri G, Squatrito S, Amore M, Zanetidou S, Neri M (2017) Physical exercise for late life depression: effects on cognition and disability. Int Psychogeriatr 29(7):1105–1112. https://doi.org/10.1017/S1041610217000576CrossRefPubMed

19.

Stanton R, Happell B, Hayman M, Reaburn P (2014) Exercise interventions for the treatment of affective disorders—research to practice. Front Psych 5:46. https://doi.org/10.3389/fpsyt.2014.00046CrossRef

20.

Beblo T (2016) Die Bedeutung kognitiver Beeinträchtigungen bei depressiven Patienten. Z Neuropsychol 27(2):69–83. https://doi.org/10.1024/1016-264X/a000174CrossRef

21.

Nuechterlein KH, Subotnik KL, Green MF, Ventura J, Asarnow RF, Gitlin MJ, Yee CM, Gretchen-Doorly D, Mintz J (2011) Neurocognitive predictors of work outcome in recent-onset schizophrenia. Schizophrenia Bull 37 Suppl 2(Suppl 2):S33-40. https://doi.org/10.1093/schbul/sbr084CrossRef

22.

Malchow B, Reich-Erkelenz D, Oertel-Knöchel V, Keller K, Hasan A, Schmitt A, Scheewe TW, Cahn W, Kahn RS, Falkai P (2013) The effects of physical exercise in schizophrenia and affective disorders. Eur Arch Psychiatry Clin Neurosci 263(6):451–467. https://doi.org/10.1007/s00406-013-0423-2CrossRefPubMed

23.

Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, Elliott R, Nuechterlein KH, Yung AR (2017) Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull 43(3):546–556. https://doi.org/10.1093/schbul/sbw115CrossRefPubMed

24.

Xu Y, Cai Z, Fang C, Zheng J, Shan J, Yang Y (2022) Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily care: a meta-analysis. Psychiatry Res 312:114560. https://doi.org/10.1016/j.psychres.2022.114560CrossRefPubMed

25.

Shimada T, Ito S, Makabe A, Yamanushi A, Takenaka A, Kawano K, Kobayashi M (2022) Aerobic exercise and cognitive functioning in schizophrenia: an updated systematic review and meta-analysis. Psychiatry Res 314:114656. https://doi.org/10.1016/j.psychres.2022.114656CrossRefPubMed

26.

Fernández-Abascal B, Suárez-Pinilla P, Cobo-Corrales C, Crespo-Facorro B, Suárez-Pinilla M (2021) In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis. Neurosci Biobehav Rev 125:535–568. https://doi.org/10.1016/j.neubiorev.2021.01.005CrossRefPubMed

27.

Oertel-Knöchel V, Mehler P, Thiel C, Steinbrecher K, Malchow B, Tesky V, Ademmer K, Prvulovic D, Banzer W, Zopf Y, Schmitt A, Hänsel F (2014) Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 264(7):589–604. https://doi.org/10.1007/s00406-014-0485-9CrossRefPubMed

28.

Shimada T, Ito S, Makabe A, Yamanushi A, Takenaka A, Kobayashi M (2019) Aerobic exercise and cognitive functioning in schizophrenia: A pilot randomized controlled trial. Psychiatry Res 282:112638. https://doi.org/10.1016/j.psychres.2019.112638CrossRefPubMed

29.

Ho RTH, Fong TCT, Wan AHY, Au-Yeung FSW, Wong CPK, Ng WYH, Cheung IKM, Lo PHY, Ng SM, Chan CLW, Chen EYH (2016) A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia. Schizophr Res 171(1–3):42–49. https://doi.org/10.1016/j.schres.2016.01.038CrossRefPubMed

30.

Miller WC, Wallace JP, Eggert KE (1993) Predicting max HR and the HR-VO2 relationship for exercise prescription in obesity. Med Sci Sports Exerc 25(9):1077–1081CrossRefPubMed

31.

Witschi T (2004) Ergotherapie. In: Rössler W (ed) Psychiatrische Rehabilitation. Kapitel Ergotherapie von Witschi, T. S. 355–363. Springer Berlin Heidelberg, Berlin, pp 356–363

32.

Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13(2):261–276. https://doi.org/10.1093/schbul/13.2.261CrossRefPubMed

33.

Franke GH (2002) Symptom-Checkliste von L.R. Derogatis (SCL-90-R) - deutsche Version. Beltz Test, Göttingen

34.

Mass R, Haasen C, Wolf K (2000) Das Eppendorfer Schizophrenie-Inventar (ESI). Entwicklung und Evaluation eines Fragebogens zur Erfassung charakteristischer Selbstwahrnehmungen kognitiver Dysfunktionen schizophren Erkrankter (The Eppendorf Schizophrenia Inventory (ESI). Development and evaluation of a questionnaire for assessment of characteristic self perception of cognitive dysfunctions by schizophrenic patients). Nervenarzt 71(11):885–892. https://doi.org/10.1007/s001150050679CrossRefPubMed

35.

Zimmermann P, Fimm B (2002) Testbatterie zur Aufmerksamkeitsprüfung (TAP). Version 2.1. Psytest, Würselen

36.

Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J (2000) Wechsler-Gedächtnistest- Revidierte Fassung der Wechsler Memory Scale. Huber, Bern

37.

Helmstaedter C, Lerndt M, Lux S (2001) Verbaler Lern-und Merkfähigkeitstest. Beltz, Göttingen

38.

Rey A (1964) L´examen clinique en psychologie. Presses Universitaires de France, Paris

39.

Raven J, Raven J (2003) Raven progressive matrices. In: McCallum RS (ed) Handbook of nonverbal assessment. Springer US, Boston, pp 223–237

40.

Drühe-Wienholt CM, Wienholt W (2011) Computergestütztes Kartensortierverfahren Manual. Swets und Zeitlinger Testservices, Frankfrurt am Main

41.

Lenhard W, Lenhard A (2022) Computation of effect sizes. Psychometrica. https://www.psychometrica.de/effektstaerke.html. Accessed 24 Nov 2023. https://doi.org/10.13140/RG.2.2.17823.92329

42.

Blumenthal JA, Babyak MA, Doraiswamy PM, Watkins L, Hoffman BM, Barbour KA, Herman S, Craighead WE, Brosse AL, Waugh R, Hinderliter A, Sherwood A (2007) Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 69(7):587–596. https://doi.org/10.1097/PSY.0b013e318148c19aCrossRefPubMedPubMedCentral

43.

Lin J, Chan SK, Lee EH, Chang WC, Tse M, Su WW, Sham P, Hui CL, Joe G, Chan CL, Khong PL, So KF, Honer WG, Chen EY (2015) Aerobic exercise and yoga improve neurocognitive function in women with early psychosis. NPJ Schizophr 1:15047. https://doi.org/10.1038/npjschz.2015.47CrossRefPubMedPubMedCentral

44.

Kimhy D, Vakhrusheva J, Bartels MN, Armstrong HF, Ballon JS, Khan S, Chang RW, Hansen MC, Ayanruoh L, Lister A, Castrén E, Smith EE, Sloan RP (2015) The impact of aerobic exercise on brain-derived neurotrophic factor and neurocognition in individuals with schizophrenia: a single-blind, randomized clinical trial. Schizophrenia Bull 41(4):859–868. https://doi.org/10.1093/schbul/sbv022CrossRef

45.

Nuechterlein KH, Ventura J, McEwen SC, Gretchen-Doorly D, Vinogradov S, Subotnik KL (2016) Enhancing cognitive training through aerobic exercise after a first schizophrenia episode: theoretical conception and pilot study. Schizophrenia Bull 42 Suppl 1(Suppl 1):S44-52. https://doi.org/10.1093/schbul/sbw007CrossRef

46.

Massa N, Alrohaibani A, Mammino K, Bello M, Taylor N, Cuthbert B, Fargotstein M, Coulter MM, Boatright JH, Nocera J, Duncan E (2020) The effect of aerobic exercise on physical and cognitive outcomes in a small cohort of outpatients with schizophrenia. Brain Plasticity (Amsterdam, Netherlands) 5(2):161–174. https://doi.org/10.3233/BPL-200105CrossRefPubMed

47.

Su C-Y, Wang P-W, Lin Y-J, Tang T-C, Liu M-F, Chen M-D (2016) The effects of aerobic exercise on cognition in schizophrenia: a 3-month follow-up study. Psychiatry Res 244:394–402. https://doi.org/10.1016/j.psychres.2016.08.011CrossRefPubMed

48.

Huang T, Larsen KT, Ried-Larsen M, Møller NC, Andersen LB (2014) The effects of physical activity and exercise on brain-derived neurotrophic factor in healthy humans: a review. Scand J Med Sci Sports 24(1):1–10. https://doi.org/10.1111/sms.12069CrossRefPubMed

49.

Ryu J, Jung JH, Kim J, Kim C-H, Lee H-B, Kim D-H, Lee S-K, Shin J-H, Roh D (2020) Outdoor cycling improves clinical symptoms, cognition and objectively measured physical activity in patients with schizophrenia: a randomized controlled trial. J Psychiatr Res 120:144–153. https://doi.org/10.1016/j.jpsychires.2019.10.015CrossRefPubMed

50.

Bang-Kittilsen G, Egeland J, Holmen TL, Bigseth TT, Andersen E, Mordal J, Ulleberg P, Engh JA (2021) High-intensity interval training and active video gaming improve neurocognition in schizophrenia: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 271(2):339–353. https://doi.org/10.1007/s00406-020-01200-4CrossRefPubMed

51.

Malchow B, Keller K, Hasan A, Dörfler S, Schneider-Axmann T, Hillmer-Vogel U, Honer WG, Schulze TG, Niklas A, Wobrock T, Schmitt A, Falkai P (2015) Effects of endurance training combined with cognitive remediation on everyday functioning, symptoms, and cognition in multiepisode schizophrenia patients. Schizophr Bull 41(4):847–858. https://doi.org/10.1093/schbul/sbv020CrossRefPubMedPubMedCentral

52.

Ruiz-Delgado I, Moreno-Küstner B, García-Medina M, Barrigón ML, Gonzalez-Higueras F, López-Carrilero R, Barrios-Mellado I, Barajas A, Pousa E, Lorente-Rovira E, Grasa E, Cid J, Barrau-Sastre P, Moritz S, Ochoa S (2022) Is Metacognitive Training effective for improving neurocognitive function in patients with a recent onset of psychosis? Psychiatry Res 318:114941. https://doi.org/10.1016/j.psychres.2022.114941CrossRefPubMed

53.

Fett A-KJ, Viechtbauer W, Dominguez M-G, Penn DL, van Os J, Krabbendam L (2011) The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 35(3):573–588. https://doi.org/10.1016/j.neubiorev.2010.07.001CrossRefPubMed

54.

Falkai P, Maurus I, Schmitt A, Malchow B, Schneider-Axmann T, Röll L, Papiol S, Wobrock T, Hasan A, Keeser D (2021) Improvement in daily functioning after aerobic exercise training in schizophrenia is sustained after exercise cessation. Eur Arch Psychiatry Clin Neurosci 271(7):1201–1203. https://doi.org/10.1007/s00406-021-01282-8CrossRefPubMedPubMedCentral

55.

Pajonk F-G, Wobrock T, Gruber O, Scherk H, Berner D, Kaizl I, Kierer A, Müller S, Oest M, Meyer T, Backens M, Schneider-Axmann T, Thornton AE, Honer WG, Falkai P (2010) Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen Psychiatry 67(2):133–143. https://doi.org/10.1001/archgenpsychiatry.2009.193CrossRefPubMed

56.

Svatkova A, Mandl RCW, Scheewe TW, Cahn W, Kahn RS, Hulshoff Pol HE (2015) Physical exercise keeps the brain connected: biking increases white matter integrity in patients with schizophrenia and healthy controls. Schizophr Bull 41(4):869–878. https://doi.org/10.1093/schbul/sbv033CrossRefPubMedPubMedCentral

57.

Firth J, Stubbs B, Vancampfort D, Schuch F, Lagopoulos J, Rosenbaum S, Ward PB (2018) Effect of aerobic exercise on hippocampal volume in humans: a systematic review and meta-analysis. Neuroimage 166:230–238. https://doi.org/10.1016/j.neuroimage.2017.11.007CrossRefPubMed

58.

Vaynman S, Ying Z, Gomez-Pinilla F (2004) Hippocampal BDNF mediates the efficacy of exercise on synaptic plasticity and cognition. Eur J Neurosci 20(10):2580–2590. https://doi.org/10.1111/j.1460-9568.2004.03720.xCrossRefPubMed

59.

Cotman CW, Engesser-Cesar C (2002) Exercise Enhances and Protects Brain Function. Exerc Sport Sci Rev 30(2):75–79CrossRefPubMed

60.

Vancampfort D, Rosenbaum S, Schuch FB, Ward PB, Probst M, Stubbs B (2016) Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. Gen Hosp Psychiatry 39:15–23. https://doi.org/10.1016/j.genhosppsych.2015.11.008CrossRefPubMed

61.

Costa R, Bastos T, Probst M, Seabra A, Vilhena E, Corredeira R (2018) Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia. Int J Psychiatry Clin Pract 22(3):184–190. https://doi.org/10.1080/13651501.2018.1435821CrossRefPubMed

62.

Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, Nieman DC, Swain DP (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefbCrossRefPubMed

Title: The impact of aerobic endurance training on cognitive performance in schizophrenic inpatients in a clinical routine setting
Authors: Elisa Semler
Florian Herpich
Leonhard Zellner
Sarah Zwick
Peter Zwanzger
Alexander Brunnauer
Publication date: 19-03-2024
Publisher: Springer Berlin Heidelberg
Keyword: Schizophrenia
Published in: European Archives of Psychiatry and Clinical Neuroscience
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-024-01773-4

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Springer Medicine

The impact of aerobic endurance training on cognitive performance in schizophrenic inpatients in a clinical routine setting

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

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