Exercise therapy for schizophrenia.
BACKGROUND
The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia.


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


METHODS
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.


METHODS
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.


METHODS
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).


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.


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.
Gorczynski
Paul
P
Faculty of Physical Education and Health, University of Toronto, 55 Harbord St, Toronto, Canada, On M5S 2W6.
Faulkner
Guy
G
D015444:Exercise / Q000523:psychology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D015013:Yoga / Q000523:psychology
JAMA. 2001 Apr 18;285(15):1987-91
11308435
Br J Med Psychol. 1978 Jun;51(2):155-9
646961
Acta Psychiatr Scand. 2007 Sep;116(3):226-32
17655565
Epidemiol Rev. 2008;30:67-76
18480098
Hosp Community Psychiatry. 1988 Nov;39(11):1172-7
2906320
Health Technol Assess. 1999;3(5):iii-92
10982317
Acta Psychiatr Scand Suppl. 1970;212:11-9
4917967
Schizophr Bull. 1987;13(2):261-76
3616518
Schizophr Res. 2005 Dec 1;80(1):45-53
16198088
BMJ. 1997 Sep 13;315(7109):629-34
9310563
Br J Psychiatry. 2000 Mar;176:249-52
10755072
Psychiatr Rehabil J. 2006 Spring;29(4):258-66
16689036
Am J Epidemiol. 1999 May 1;149(9):876-83
10221325
J Gen Intern Med. 1992 Nov-Dec;7(6):623-9
1453246
Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1384-7
9817683
Evid Based Nurs. 2001 Jan;4(1):4-6
11707879
Med J Aust. 2003 May 5;178(S9):S67-70
12720526
Therapie. 1999 Jul Aug;54(4):405-11
10667106
Aust N Z J Psychiatry. 2001 Apr;35(2):196-202
11284901
Stat Med. 2002 Oct 15;21(19):2971-80
12325113
J Clin Epidemiol. 2004 Jun;57(6):543-50
15246122
Br J Clin Psychol. 1986 May;25 ( Pt 2):125-33
3730648
BMJ. 1997 Sep 6;315(7108):600
9302962
JAMA. 2008 Jan 9;299(2):185-93
18182600
Br J Clin Psychol. 2007 Mar;46(Pt 1):95-111
17472204
BMJ. 2001 Jul 7;323(7303):42-6
11440947
Nervenarzt. 1991 May;62(5):283-7
1865958
Qual Life Res. 2004 Mar;13(2):299-310
15085902
J Clin Epidemiol. 1998 Nov;51(11):903-12
9817107
J Psychiatr Ment Health Nurs. 2008 Dec;15(10):808-15
19012672
Issues Ment Health Nurs. 2005 Jul;26(6):661-76
16020076
Schizophr Res. 2006 Jan 31;81(2-3):301-9
16256309
BMJ. 1996 Nov 9;313(7066):1200
8916759
Psychiatr Rehabil J. 2005 Fall;29(2):122-7
16268007
J Consult Clin Psychol. 1983 Oct;51(5):730-42
6630688
JAMA. 1996 Aug 28;276(8):637-9
8773637
Public Health Rep. 1985 Mar-Apr;100(2):126-31
3920711
Psychol Med. 1999 May;29(3):697-701
10405091
Psychiatr Serv. 2007 Apr;58(4):544-50
17412858
Curr Opin Psychiatry. 2008 Jul;21(4):398-402
18520746
BMJ. 2003 Sep 6;327(7414):557-60
12958120