Efficacy and feasibility of aerobic exercise interventions as an adjunctive treatment for patients with schizophrenia: a meta-Analysis

Abstract

Schizophrenia is a chronic mental disorder primarily treated with antipsychotics, which have limited efficacy for negative symptoms. This study aims to evaluate the effectiveness and feasibility of exercise interventions as adjuncts to pharmacotherapy through a meta-analysis, providing valuable insights for rational intervention design. Four databases were searched, and randomized controlled trials with no language restrictions published up to March 27, 2023, were included. The primary outcome indicator was the Positive and Negative Symptom Scale (PANSS) total score along with its three sub-scales. Secondary outcomes included the Scale for Assessment of Negative Symptoms (SANS) and Body Mass Index (BMI), which were used to assess the efficacy of aerobic exercise interventions in patients with schizophrenia. Subgroup analyses were conducted to explore the impact of intervention duration and total weekly exercise time, while treatment feasibility was assessed through adherence rates. A total of 17 publications involving 973 patients with schizophrenia were deemed eligible and included in the analysis. Compared to other forms of adjunctive interventions, the network meta-analysis of 12 PANSS-based studies revealed that adjunctive aerobic exercise interventions were the most effective in reducing overall PANSS scores in patients with schizophrenia, with statistically significant pooled results (MD = -4.84, 95% CI: -5.72, -3.96). Both the PANSS negative symptom subscale (MD = -2.11, 95% CI: -3.26, -0.95) and SANS (MD = -9.11, 95% CI: -11.94, -6.27) indicated that adjunctive aerobic exercise interventions effectively alleviate negative symptoms. Subgroup meta-analysis indicated that 2-3 month interventions involving 100-220 min of exercise per week were the most effective. Additionally, adherence to the adjunctive aerobic exercise regimen was found to be comparable to that of conventional treatment alone. Aerobic exercise interventions, as adjunctive therapy, are an effective measure for reducing PANSS scores in patients with schizophrenia, contributing to the alleviation of both the positive and negative symptoms, and patients demonstrated strong adherence to aerobic exercise.

Fig. 1. Flow chart of the included studies.

The figure represents the amount of literature excluded/included after each step.

Fig. 2. Bias risk analysis of the included literature.

Literature quality assessment results showed a good quality and a low bias risk of the included articles.

Fig. 3. Network evidence plot.

TAU Treatment As Usual, AE Conventional Therapy + Aerobic Exercise Intervention, AP Conventional therapy + Aerobic intervention + Psychological intervention, NAE Non-single Aerobic Exercise.

Fig. 4. Cumulative ranking of interventions.

TAU treatment as usual, AE conventional therapy + aerobic exercise intervention, AP conventional therapy + aerobic intervention +psychological intervention, NAE non-single aerobic exercise, SUCRA surface under the cumulative ranking.

Fig. 5. Forest plot.

A PANSS total score forest plot. B SANS total score forest plot.

Fig. 6. Overall funnel chart.

The dotted lines represent 95% confidence intervals, and the dots represent studies.