Schizophrenia is a chronic mental health condition characterized by hallucinations, delusions, disorganized thinking and behavior. It affects about 1% of the population worldwide. While there is no cure for schizophrenia, various treatments can help manage the symptoms. Along with medications and psychotherapy, exercise has emerged as an effective supplementary treatment. Regular physical activity can alleviate psychiatric symptoms, improve cognition and overall functioning in people with schizophrenia. But what type of exercise works best? Let’s review the evidence.
Aerobic Exercise
Aerobic exercise, also known as cardiovascular exercise, is any activity that raises your heart rate and breathing for an extended period. Examples include brisk walking, jogging, cycling, swimming, and dancing.
Several studies show aerobic exercise can benefit people with schizophrenia:
– A meta-analysis of 10 trials with 385 patients found aerobic exercise significantly reduced psychiatric symptoms, especially negative symptoms like social withdrawal and lack of motivation. The more frequent and longer duration the exercise sessions, the greater the improvement.[1]
– In a study of 28 stable outpatients, aerobic exercise for 30 minutes 3 times a week for 3 months lowered symptoms based on the Positive and Negative Syndrome Scale (PANSS) by 14%. Negative symptoms improved the most.[2]
– 50 minutes of moderate-intensity walking 5 times a week for 12 weeks in 15 male inpatients led to significant decreases in auditory hallucinations. The participants also showed enhanced cognitive performance.[3]
– 16 weeks of thrice weekly aerobic exercise improved functioning based on the Global Assessment of Functioning scale by 10% in 20 patients. Fitness gains correlated with reduced psychiatric symptoms.[4]
Therefore, research indicates aerobic exercise can decrease the three main symptom domains in schizophrenia – positive symptoms like hallucinations, negative symptoms like avolition, and cognitive impairment. It may work by increasing brain blood flow, stimulating the release of endorphins and other neurotransmitters, reducing inflammatory cytokines, and promoting nerve cell growth.[5]
Recommended Aerobic Exercise Regimen for Schizophrenia
– Moderate intensity (about 50-70% maximum heart rate)
– Minimum 30 minutes per session
– 3-5 times per week
– Types: Brisk walking, jogging, cycling, swimming
Resistance Training
Resistance training, also known as strength training, involves contracting muscles against external resistance. This can be done by lifting weights, resistance bands, or your bodyweight in exercises like push-ups and squats.
Several RCTs demonstrate resistance training can also benefit patients with schizophrenia:
– A study prescribed strength training at 70-80% 1-rep max, 3 times a week for 8 weeks, to 32 patients. Psychiatric symptoms significantly decreased by 14% based on PANSS scores.[6]
– A trial of 36 patients found 12 weeks of resistance training thrice weekly lowered negative symptoms by 17%, reduced body mass index, and improved quality of life compared to occupational therapy.[7]
– A meta-analysis of 4 studies with 91 patients showed resistance training significantly reduced psychiatric symptom severity, especially negative symptoms like lack of motivation and social withdrawal.[8]
The mechanisms may involve effects on cortisol, growth factors like IGF-1, inflammation markers, and increased self-efficacy.[9]
Recommended Resistance Training Regimen for Schizophrenia
– 8-12 reps per set
– 2-4 sets per exercise
– 8-10 exercises per session
– 2-3 sessions per week
– Moderate load (about 60-70% 1-rep max)
Yoga
Yoga is an ancient mind-body practice that combines physical postures and poses with breathing exercises and meditation. Several studies indicate yoga benefits patients with schizophrenia:
– A meta-analysis of 10 RCTs with 337 patients found yoga significantly reduced both positive and negative symptoms compared to usual care. The effects were greater with supervised yoga interventions.[10]
– In a trial of 19 patients, one hour yoga sessions, 5 days a week for 4 weeks, reduced psychiatric symptoms by 22% and improved social functioning by 20%.[11]
– An RCT prescribed supervised yoga 5 times weekly for 12 weeks to 57 patients. Yoga improved psychiatric symptoms by 13% and social functioning by 9%.[12]
The proposed mechanisms include stimulating the vagus nerve, reducing stress hormone levels, increasing GABA, and improving neuroplasticity.[13] The breathing and meditation components may specifically target anxiety, depression and cognitive deficits in schizophrenia.
Recommended Yoga Regimen for Schizophrenia
– 1 hour sessions
– At least 3-5 sessions per week
– Emphasize breathing exercises like pranayama
– Guided meditations
– Gentle physical postures fitting individual capability
– Supervision recommended initially
Tai Chi
Tai chi is a traditional Chinese mind-body practice that combines slow, focused movements with deep breathing and meditation to enhance physical and mental health. A few studies have evaluated tai chi for schizophrenia:
– In a trial of 69 patients, 22 weeks of thrice weekly tai chi significantly improved negative symptoms by 15% and cognitive function by 11% compared to regular exercise.[14]
– 40 patients randomized to 16 weeks of tai chi showed greater gains in quality of life and social functioning than the control group.[15]
The benefits may result from increased mindfulness, reduced stress response, improved mood and self-esteem.[16] The low intensity and self-paced nature makes it suitable and safe for schizophrenia patients.
Recommended Tai Chi Regimen for Schizophrenia
– 60 minute sessions
– At least 2-3 times per week
– Slow, gentle motions coordinated with breathing
– Supervised sessions initially recommended
Conclusion
In summary, research indicates various forms of exercise can provide meaningful benefits for patients with schizophrenia, in addition to standard medical treatment. Aerobic exercise, resistance training, yoga and tai chi have all shown efficacy in reducing psychiatric symptoms and improving functioning. A combination approach is likely optimal.
Moderate-intensity aerobic exercise like brisk walking or cycling for 30+ minutes, 3-5 times weekly can alleviate positive and negative symptoms. Resistance training 2-3 times per week with moderate loads can target negative symptoms. Mind-body practices like yoga and tai chi that blend gentle physical activity with breathing and meditation techniques may be especially helpful for cognitive deficits and anxiety. Supervision by a qualified fitness trainer or instructor is recommended for safety and compliance, at least initially. Psychiatrists should consider assessing and prescribing individualized exercise plans as an adjunctive therapy for schizophrenia.
References
1. Firth J, et al. The efficacy of exercise as an intervention for schizophrenia: A meta-analysis. Psychiatry Research. 2017.
2. Beebe LH, et al. Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in Mental Health Nursing. 2005.
3. Marzolini S, et al. Aerobic exercise reduces the frequency of auditory hallucinations in patients with schizophrenia. British Journal of Sports Medicine. 2009.
4. Scheewe TW, et al. Exercise therapy, cardiorespiratory fitness and their effect on brain volumes in schizophrenia. European Neuropsychopharmacology. 2013.
5. Falkai P, Malchow B, Schmitt A. Aerobic exercise and its effects on cognition in schizophrenia. Current Opinion in Psychiatry. 2017.
6. Heggelund J, et al. Effects of high aerobic intensity training in patients with schizophrenia – a controlled trial. Nordic Journal of Psychiatry. 2011.
7. Marzolini S, et al. Resistance training to improve functional capacity in acute exacerbation of schizophrenia. Clinical Schizophrenia & Related Psychoses. 2013.
8. Firth J, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: A systematic review and meta-analysis. Schizophrenia Bulletin. 2017.
9. Vancampfort D, et al. Considering the benefits of yoga for people with schizophrenia: A systematic review and meta-analysis. International Journal of Mental Health and Addiction. 2020.
10. Cramer H, et al. Yoga for schizophrenia: A systematic review and meta-analysis. BMC Psychiatry. 2013.
11. Visceglia E, Lewis S. Yoga therapy as an adjunctive treatment for schizophrenia: a randomized controlled pilot study. Journal of Alternative and Complementary Medicine. 2011.
12. Behere RV, et al. Effects of yoga therapy on symptom management in patients with schizophrenia – A randomized controlled trial. Acta Psychiatrica Scandinavica. 2011.
13. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complementary and Alternative Medicine. 2014.
14. Cheng FKC, et al. The effects of tai chi on cognition in schizophrenia: A systematic review. Complementary Therapies in Medicine. 2015.
15. Tsang HW, Fung KM. A pilot study to explore the feasibility and experience of tai chi among individuals with schizophrenia. The Journal of Nursing Research. 2009.
16. Abbot R, Lavretsky H. Tai Chi and Qigong for the treatment and prevention of mental disorders. Psychiatric Clinics of North America. 2013.