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Current treatment methods do not achieve recovery for most individuals with schizophrenia, and symptoms such as negative symptoms and cognitive deficits often persist. Aerobic endurance training has been suggested as a potential add-on treatment targeting both physical and mental health. We performed a large-scale multicenter, rater-blind, parallel-group randomized controlled clinical trial in individuals with stable schizophrenia. Participants underwent a professionally supervised six-month training comprising either aerobic endurance training (AET) or flexibility, strengthening, and balance training (FSBT, control group), follow-up was another six months. The primary endpoint was all-cause discontinuation (ACD); secondary endpoints included effects on psychopathology, cognition, functioning, and cardiovascular risk.
In total, 180 participants were randomized. AET was not superior to FSBT in ACD and most secondary outcomes, with dropout rates of 59.55% and 57.14% in the six-month active phase, respectively. However, both groups showed significant improvements in positive, general, and total symptoms, levels of functioning and in cognitive performance. A higher training frequency additionally promoted further memory domains. Participants with higher baseline cognitive abilities were more likely to respond to the interventions.
Our results support integrating exercise into schizophrenia treatment, while future studies should aim to develop personalized training recommendations to maximize exercise-induced benefits.
Exercise interventions are nowadays considered as effective add-on treatments in people with schizophrenia but are usually associated with high dropout rates. Therefore, the present study investigated potential predictors of adherence from a large multicenter study, encompassing two types of exercise training, conducted over a 6-month period with individuals with schizophrenia. First, we examined the role of multiple participants’ characteristics, including levels of functioning, symptom severity, cognitive performance, quality of life, and physical fitness. Second, we used K-means clustering to identify clinical subgroups of participants that potentially exhibited superior adherence. Last, we explored if adherence could be predicted on the individual level using Random Forest, Logistic Regression, and Ridge Regression. We found that individuals with higher levels of functioning at baseline were more likely to adhere to the exercise interventions, while other factors such as symptom severity, cognitive performance, quality of life or physical fitness seemed to be less influential. Accordingly, the high-functioning group with low symptoms exhibited a greater likelihood of adhering to the interventions compared to the severely ill group. Despite incorporating various algorithms, it was not possible to predict adherence at the individual level. These findings add to the understanding of the factors that influence adherence to exercise interventions. They underscore the predictive importance of daily life functioning while indicating a lack of association between symptom severity and adherence. Future research should focus on developing targeted strategies to improve adherence, particularly for people with schizophrenia who suffer from impairments in daily functioning.
Regular physical activity can prevent various physical and mental illnesses or improve their prognosis. However, only about half of the German population meets the WHO recommendations for physical activity. The aim of this study was to identify factors that influence engagement in regular exercise and could help increase physical activity levels in the general population. To this end, we conducted a cross-sectional study using questionnaire instruments and self-designed items. The research cohort comprised a sample of online-acquired data from 1,119 mentally healthy individuals. Higher regular exercise was associated with higher both intrinsic and extrinsic motivation, self-efficacy, resilience, internal locus of control, and risk-taking behaviour, as well as higher scores in the personality traits conscientiousness, extraversion, and agreeableness. Higher regular exercise was also linked to lower external locus of control. Whether participants exercised was also related to external circumstances, such as their financial situation, whether family members frequently exercised during childhood or the availability of sports facilities. Furthermore, participants' preferred exercise environment was found to be different from reality. Despite expressing a preference for outdoor and group exercise, most participants reported exercising alone and indoors. People who exercised regularly during childhood stated higher levels of intrinsic as well as extrinsic motivation and resilience. Based on our findings, we suggest that additional low-threshold, low-cost opportunities for physical exercise should be provided in public spaces that lack exercise facilities, as well as in childcare settings with a particular focus on disadvantaged social groups.
Objective
Regular exercise significantly benefits mental health, yet its therapeutic potential in psychiatric care remains underutilised. Understanding the factors influencing physical activity in individuals with mental illness is crucial to realising its full therapeutic potential. Our study seeks to explore motivational and socio-demographic determinants affecting exercise habits in individuals with mental illness and compare them to those without mental illness.
Design and setting
Distribution of the link to a cross-sectional online survey at psychiatric clinics, practices, university events and sports clubs, via self-help group email lists and on social media.
Methods
An online survey using validated questionnaires supplemented with self-developed items was conducted. Statistical analysis encompassed unpaired t-tests and χ2 tests to compare individuals with and without mental illness, as well as multiple linear regression to investigate the relationship between childhood exercise experience, psychometrics and current physical activity behaviour in individuals with mental illness.
Participants
1564 individuals (66.5% female) including 417 diagnosed with any kind of mental illness.
Results
In comparison with mentally healthy participants, individuals diagnosed with mental illness displayed notably lower activity levels (eg, engaging in regular physical activity 55.6% vs 69.3%, x2(1, n=1458) = 26.03, p<0.001), autonomous motivation (sport- und bewegungsbezogene Selbstkonkordanzskala Index: M=3.62, SD=3.07 vs M=4.62, SD=2.74, t(594.58)=5.4, p=0.009), self-efficacy expectancies (Allgemeine Selbstwirksamkeit Kurzskala: M=3.65, SD=0.81 vs M=4.10, SD=0.59, t(505.39)=9.76, p<0.001), and resilience (Brief Resilience Scale: M=2.81, SD=0.83 vs M=3.46, SD=0.70, t(555.52)=13.28, p<0.001), and a greater external locus of control (Internale-Externale-Kontrollüberzugung Scale: M=2.53, SD=0.89 vs M=2.13, SD=0.76, t(565.43)=−7.78, p<0.001). Throughout childhood and adolescence, they reported less activity (66.9% vs 78.0%, x2(1, n=1549) = 18.22, p<0.001) and lower grades in physical education (M=2.1, SD=0.8 vs M=1.8, SD=0.8, U=1 888 071.00, Z=−6.19, p<0.001). Individuals with mental illness favoured a structured sports programme led by professionals. Factors like self-concordance (ß=0.29, p<0.001), intrinsic motivation (ß=0.22, p=0.02), and self-efficacy expectations (ß=0.35, p<0.001) were strong predictors of current physical activity levels (eg, measured as training sessions per week) in this group.
Conclusion
There is a dire need for professionally supervised, small group exercise programmes for people with mental illness incorporating cognitive-behavioural elements, to better address their individual needs and to positively influence previously mentioned psychometric determinants. Furthermore, the importance of sport and physical activity in childhood, and especially in adolescence, was reaffirmed, underlining the paramount importance of youth sport programmes in long-term health promotion from a public health perspective.
