title: Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis.
abstract: Cognitive deficits are pervasive among people with schizophrenia and treatment options are limited. There has been an increased interest in the neurocognitive benefits of exercise, but a comprehensive evaluation of studies to date is lacking. We therefore conducted a meta-analysis of all controlled trials investigating the cognitive outcomes of exercise interventions in schizophrenia. Studies were identified from a systematic search across major electronic databases from inception to April 2016. Meta-analyses were used to calculate pooled effect sizes (Hedges g) and 95% CIs. We identified 10 eligible trials with cognitive outcome data for 385 patients with schizophrenia. Exercise significantly improved global cognition (g = 0.33, 95% CI = 0.13-0.53, P = .001) with no statistical heterogeneity (I2 = 0%). The effect size in the 7 studies which were randomized controlled trials was g = 0.43 (P < .001). Meta-regression analyses indicated that greater amounts of exercise are associated with larger improvements in global cognition (β = .005, P = .065). Interventions which were supervised by physical activity professionals were also more effective (g = 0.47, P < .001). Exercise significantly improved the cognitive domains of working memory (g = 0.39, P = .024, N = 7, n = 282), social cognition (g = 0.71, P = .002, N = 3, n = 81), and attention/vigilance (g = 0.66, P = .005, N = 3, n = 104). Effects on processing speed, verbal memory, visual memory and reasoning and problem solving were not significant. This meta-analysis provides evidence that exercise can improve cognitive functioning among people with schizophrenia, particularly from interventions using higher dosages of exercise. Given the challenges in improving cognition, and the wider health benefits of exercise, a greater focus on providing supervised exercise to people with schizophrenia is needed.
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.|These joint-first authors contributed equally to the writing of this manuscript.
authors: Joseph
authors: J
authors: Firth
authors: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|These joint-first authors contributed equally to the writing of this manuscript.
authors: Brendon
authors: B
authors: Stubbs
authors: Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors: Simon
authors: S
authors: Rosenbaum
authors: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.|KU Leuven Department of Neurosciences, UPC KU Leuven, Leuven, Belgium.
authors: Davy
authors: D
authors: Vancampfort
authors: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
authors: Berend
authors: B
authors: Malchow
authors: Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors: Felipe
authors: F
authors: Schuch
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.|School of Psychological Sciences, University of Manchester, Manchester, UK.
authors: Rebecca
authors: R
authors: Elliott
authors: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.|Department of Psychology, University of California, Los Angeles, Los Angeles, CA.
authors: Keith H
authors: KH
authors: Nuechterlein
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.|Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK.
authors: Alison R
authors: AR
authors: Yung
mesh_terms: D060825:Cognitive Dysfunction / Q000209:etiology / Q000534:rehabilitation*; D015444:Exercise; D006801:Humans; D012559:Schizophrenia / Q000150:complications / Q000534:rehabilitation*
keywords: cognition; neurocognition; neurocognitive; physical activity; psychosis