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Meta-Analysis
. 2010 May 12:(5):CD004412.
doi: 10.1002/14651858.CD004412.pub2.

Exercise therapy for schizophrenia

Paul Gorczynski  1 , Guy Faulkner
Affiliations
Meta-Analysis

Exercise therapy for schizophrenia

Paul Gorczynski et al. Cochrane Database Syst Rev. .

Abstract

Background: The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia.

Objectives: To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses.

Search strategy: We searched the Cochrane Schizophrenia Group Trials Register (December 2008) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We also inspected references within relevant papers.

Selection criteria: We included all randomised controlled trials comparing any intervention where physical activity or exercise was considered to be the main or active ingredient with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses.

Data collection and analysis: We independently inspected citations and abstracts, ordered papers, quality assessed and data extracted. For binary outcomes we calculated a fixed-effect risk ratio (RR) and its 95% confidence interval (CI). Where possible, the weighted number needed to treat/harm statistic (NNT/H) and its 95% confidence interval (CI), was also calculated. For continuous outcomes, endpoint data were preferred to change data. We synthesised non-skewed data from valid scales using a weighted mean difference (WMD).

Main results: Three randomised controlled trials met the inclusion criteria. Trials assessed the effects of exercise on physical and mental health. Overall numbers leaving the trials were similar. Two trials (Beebe 2005 and Marzaloni 2008) compared exercise to standard care and both found exercise to significantly improve negative symptoms of mental state (Mental Health Inventory Depression: 1RCT, n=10, MD 17.50 CI 6.70 to 28.30, PANNS negative: 1RCT, n=10, MD -8.50 CI -11.11 to -5.89). No absolute effects were found for positive symptoms of mental state. Physical health improved significantly in the exercise group compared to those in standard care (1RCT, n=13, MD 79.50 CI 33.82 to 125.18), but no effect on peoples' weight/BMI was apparent. Duraiswamy 2007 compared exercise with yoga and found that yoga had a better outcome for mental state (PANNS total: 1RCT, n=41, MD 14.95 CI 2.60 to 27.30). The same trial also found those in the yoga group had significantly better quality of life scores (WHOQOL Physical: 1RCT, n=41, MD -9.22 CI -18.86 to 0.42). Adverse effects (AIMS total scores) were, however, similar.

Authors' conclusions: Results of this Cochrane review are similar to existing reviews that have examined the health benefits of exercise in this population (Faulkner 2005). Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia. Larger randomised studies are required before any definitive conclusions can be drawn.

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Figures

Figure 1
Figure 1
Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.
Figure 2
Figure 2
Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.
See this image and copyright information in PMC

References

References to studies included in this review

    1. Beebe LH, Tian L, Morris N, Goodwin A, Allen SS, Kuldau J. Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in Mental Health Nursing. 2005;26(6):661–76. [PUBMED: 16020076] - PubMed
    1. Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia - a randomized controlled trial. Acta Psychiatrica Scandinavica. 2007;116(3):226–32. [PUBMED: 17655565] - PubMed
    1. Marzaloni S, Jensen B, Melville P. Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with schizophrenia: a multidisciplinary approach. Mental Health and Physical Activity. 2009;2(1):29–36.

References to studies excluded from this review

    1. Acil AA, Dogan S, Dogan O. The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of Psychiatric and Mental Health Nursing. 2008;15:808–15. - PubMed
    1. Adams L. Randomized control trial of the effects of an exercise intervention programme on the symptomatology of people with schizophrenia. The pilot study.. National Research Register. 2001
    1. Apter A, Sharir I, Tyano S, Wijsenbeek H. Movement therapy with psychotic adolescents. British Journal of Medical Psychology. 1978;51:155–59. - PubMed
    1. Hu Q-L, Xue L-H, Gao X-H. Effect of music-sport therapy on the insight and behavioral disturbance in patients with schizophrenia. Zhongguo Linchuang Kangfu. 2004;8(9):1626–27.
    1. Li M, Wang H, Li X. Effect of music and sport therapy as assistant treatment for schizophrenia. Heilongjiang Nursing Journal. 2005;11(20):1677–78.

References to studies awaiting assessment

    1. Lin MR. The effect of ’sit ups’ on constipation in patients with schizophrenia. International Journal of Nursing. 2006;25(1):58–9.
    1. Nilsberg G. Aerobic endurance training and effect on symptoms of schizophrenia. 2006 http://www.clinicaltrials.gov
    1. Ning XH, Chen YX, Lu F. The effect of jianshen gymnastics on the negative symptoms of schizophrenia. Chinese journal of Behavioral Medical Science. 2003;7478(3):329.
    1. Scheidhacker M, Bender W, Vaitl P. The efficacy of horse-riding in the treatment of chronic schizophrenic patients [Die wirksamkeit des therapeutischen reitens bei behandlung chronisch schizophrener patienten: experimentelle ergebnisse und klinische erfahrungen] Nervenarzt. 1991;62:283–7. - PubMed
    1. Wu J. The role of exercise rehabilitation in chronic schizophrenic patients. Medical Journal of Chinese People’s Health. 2007;19(17):799, 801.

References to ongoing studies

    1. Lindamer L, Delapena J. Adapting a physical activity intervention for schizophrenia. 2006 http://www.clinicaltrials.gov

Additional references

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