Background
Methods
Eligibility criteria
Search Methods, and study selection
Data extraction and analysis
Quality assessment
Results
Study characteristics
Study | Study outline | Description of intervention |
---|---|---|
Beebe et al. [41] | Study to assess the effectiveness of an exercise programme on the physical and mental health of individuals with schizophrenia. | Intervention to determine whether an exercise programme can improve the physical and mental health of individuals with schizophrenia. |
12 participants, random allocation to two groups, intervention and control group (randomisation schedule by statistician). 16 week intervention. | ||
Intervention group – treadmill exercise programme, meeting 3 times/week for 16 weeks. Programme consisted 10 minutes warm-up session, treadmill walking, then 10 minutes of cool-down exercises. Treadmill walking session gradually increased from 5 minutes to 30 minutes per episode for rest of study. | ||
Control Group – no exercise programme offered to this group, until end of study. | ||
Attendance – 43% to 91% of total sessions offered, 75% attended half of sessions, 50% attended 2/3. | ||
Assessments – demographics, weight/ height/ BMI, 6-Minute Walking Distance (6 MWD), Percentage Body Fat, Positive and Negative Syndrome Scale Scores (PANSS). | ||
Skrinar et al. [45] | Study to assess the impact of an exercise programme in individuals with serious mental illness. | Intervention of patients with mood and psychotic illness. To determine the effect of a 12 week exercise programme on physical and mental health measures. |
12 week programme. 2 groups - intervention group and control group. Patients randomly assigned. | ||
Intervention group – 4 exercise per week for 12 weeks + one health seminar per week. Aerobic and cardiovascular training and cool-down each session, increasing intensity of exercise. Health seminar topics – healthy eating, weight management, stress relief, spirituality and wellness. | ||
Control group – normal care, although offered exercise programme end of study + asked to keep record of amount of exercise they will do during control phase. | ||
Assessments – demographics, weight, height, pulse, blood pressure, blood tests, Symptom Checklist- 90- R, Lehman Quality of Life Questionnaire, Boston University Making Decisions Questionnaire, MOS 36- Item Short-Form Health Survey (SF- 36). Pre and post-intervention assessment. | ||
Acil et al. [47] | Study to determine the of 10 week exercise programme v. control, in patients with schizophrenia. | 10 week programme using intervention and control group. Mixed group of inpatients and outpatients. Randomised two groups. |
Intervention group – 10 week, 3 days per week, and 40 min. per intervention session. | ||
Aerobic exercise programme for first 2 weeks with 25 min. per day. Starts with 10 min. work up then 25 min. aerobic exercise. Finally 5 min. cooling down. | ||
Control group – no details of control group. | ||
Baseline assessment – following assessments:- demographic data, heart rate, Scale for Assessment for Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Brief Symptom Inventory (BSI), World Health Organization Quality of Life Scale-Turkish Version (WHOQOL-BREF-TR). | ||
Marzolini et al. [46] | Study to assess the effectiveness of an exercise programme for individuals with schizophrenia. | Intervention to determine the efficacy of a group-based exercise programme. Multidisciplinary approach using a resistance and aerobic exercise programme. |
Intervention over 12 weeks. 2 groups, exercise group and usual care (control). Randomised allocation. | ||
Intervention – exercise twice per week for 12 weeks at local recreation centre + once per week additional aerobic exercise session individually or during home-visit from mental health clinician. Advised to exercise to same pace and duration at home. | ||
Control Group – “usual care” continued. No other intervention except measurement at baseline and 12 weeks. | ||
Assessments – demographic history, weight/BMI, waist/hip circumference, resting blood pressure, functional exercise capacity (6-Minute Walking Distance), muscular strength (one repetition maximum test), anthropometric measurements, adherence to exercise tests, Mental Health Inventory (MHI), self designed feedback questionnaire. | ||
Beebe et al. [43] | Study to determine the effect of effect of exercise advice and techniques, motivational interviewing skills, and a walking programme compared with the control comprising a walking group only in people with schizophrenia spectrum disorders. | Randomised controlled trial of an intervention to effect of exercise advice and techniques, motivational interviewing skills, and a walking programme compared with the control, comprising a walking group only - in people with schizophrenia spectrum disorders. 16 week walking programme with intervention and control group. WALC-P versus TAC |
Intervention – WALC-S programme – Walk (discuss walking/information/advice), Address Sensations (discussion about discomforts warming up or cooling down, suggestions to minimise problems), Learn about Exercise (information on exercise benefits and barriers), Cue Exercise (calendars or times to start walking, with reminder calls etc.). | ||
Control group – TAC group (time and attention control) consisted of 4 weekly, 1 hour (8–9 subjects per group) – focussing on health behaviour, smoking, relaxation, medication adherence. | ||
All patients attended walking group for 16 weeks. Assessments – demographic data, walking group attendance, walking group persistence and compliance. | ||
Methapatara et al. [44] | Study to examine the effects of a walking programme in individuals with schizophrenia. | Study to compare the effects of a walking programme combined with motivational interviewing in patients with schizophrenia who are overweight or obese. |
Randomised open label, parallel controlled trial of 12 week duration. Patients with schizophrenia with a BMI of 23 kg/m2. Intervention compared with the control in ratio 1:1. Programme started pre-discharge in hospital for 1 week. Advised to increase walking post-discharge. | ||
Intervention Group – five 1 hour sessions. Individual motivational interviews given at first session focussing on adequate daily walking. Second session involved group education on nutrition, exercise, warming up, cooling down, and start of use of pedometers. Minimum of 3000 steps per day recommended level of walking. | ||
Fourth session group walking. Individuals encouraged to increase walking at other times. Fifth session – feedback on programme/progress. | ||
Control Group – received usual care only. No pedometer given. | ||
Assessments demographics,, body weight, waist circumference, CGI-Severity, MMSE-Thai. | ||
Scheewe et al. [42] | Study to assess the effectiveness of exercise therapy on cardiorespiratory fitness (CRF) in individuals with schizophrenia. | Intervention to study the effect of an exercise intervention on CRF in patients with schizophrenia compared with matched controls. Trial part of the TOPFIT project. Twenty four week programme. Sixty-three patients with schizophrenia and 55 controls randomised. Randomisation computer generated, stratified for gender, recruitment site and BMI. Four centres, community recruitment. |
Intervention – 1:1 allocation of exercise or occupational therapy. Exercise consists of cycling, rowing, hiking and muscle exercises. Two times a week for 1 hour. Occupational therapy consisted of computer operations, drawing, sculpting and painting. | ||
Control group - exercise or life as usual. Assessments – Scheewe et al., 2012: CRF assessed using a Cardiopulmonary exercise test (CPET) – stepwise incremental protocol to exhaustion on an upright cycle ergometer. Terminated at voluntary exhaustion. Physiological measurements – blood pressure, heart rate, oxygen update, peak minute ventilation. Scheewe et al., 2013: PANSS, MADRS, Camberwell Assessment of need (CAN), body mass index, waist circumference, blood pressure, blood parameters. Scheewe et al., 2013: Global brain volumes, hippocampal volume, and cortical thickness. | ||
Pelham et al. [48] | Study to assess the impact of an exercise programme in individuals with serious mental illness. | Intervention to assess the effect of an exercise programme using cycling as the method of exercise activity compared to a control. 12 week programme. Eight patients with schizophrenia and 2 with bipolar affective disorders. Total 10 patients in programme. Randomisation into two equal groups. Based in psychiatric rehabilitation services. |
Intervention – exercise activity on a cycle ergometer. Four sessions per week for 30 minutes at 65% to 75% of heart rate reserve. | ||
Control – muscle tone and strengthening exercises, 4 times per week for 30 minutes each session. Short intermittent bouts used within this to keep heart rate below 110 beats per minute. | ||
Assessments – VO2 max tests, Becks Depression Inventory, and weight measurements. |
Study | Country | Participants & setting | Design | Recruitment | Baseline sample | Number completing trial | Methodological issues/Risk of bias |
---|---|---|---|---|---|---|---|
Beebe et al. [41] | USA | Patients attending outpatient clinic at a Veterans Hospital | RCT | Volunteers | 12 | 10 | Participants – eligibility criteria specified - yes |
- standardised diagnostic criteria - Yes | |||||||
- non-random recruitment | |||||||
- similar baseline groups | |||||||
Intervention – details of therapists training not indicated | |||||||
- no treatment manual | |||||||
- compliance of medication non- checked | |||||||
Measurement of Outcome | |||||||
- outcome assessors blinded to treatment allocation | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation- unclear | |||||||
allocation concealment- unclear | |||||||
blinding of participants, personnel and outcome assessors - yes | |||||||
incomplete data outcome - yes | |||||||
free of selective outcome reporting- yes | |||||||
free of other sources of bias- yes | |||||||
Small sample, majority male, control group awareness of exercise programme. | |||||||
Attendance at sessions variable. | |||||||
Skrinar et al. [45] | USA | Patients from inpatient, partial hospitalisation, outpatient and community centres in area of McLean Hospital. | RCT | Selection/ invitation | 30 | 20 | Participants – eligibility criteria specified - yes |
- standardised diagnostic criteria -yes | |||||||
- non-random recruitment | |||||||
- similar baseline groups – | |||||||
Intervention – details of therapists training not indicated | |||||||
- no treatment manual | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded to treatment allocation | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation - unclear | |||||||
allocation concealment - unclear | |||||||
blinding of participants, personnel and outcome assessors - no | |||||||
incomplete data outcome - no | |||||||
free of selective outcome reporting - yes | |||||||
free of other sources of bias - yes | |||||||
Small sample, variable adherence to programme and attendance, inclusion criteria include mood disorders as well. | |||||||
Control group may be affected by exercise “influence” of study. | |||||||
Acil et al. [47] | Turkey | Inpatient and outpatient. Diagnosis of schizophrenia | RCT | Recruitment method not described, 30 outpatients and inpatients. | 30 | 30 | Participants – eligibility criteria poorly specified |
- standardised diagnostic criteria- yes | |||||||
- non-random recruitment | |||||||
- similar baseline group | |||||||
Intervention – details of therapists training not indicated | |||||||
- no treatment manual | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation - no | |||||||
allocation concealment - no | |||||||
blinding of participants, personnel and outcome assessors - no | |||||||
incomplete data outcome - unclear | |||||||
free of selective outcome reporting - unclear | |||||||
free of other sources of bias - yes | |||||||
Non-standardized exercise intervention. No measurement of existing exercise level or patient participation in the programme. | |||||||
Number completed trial not given. | |||||||
Marzolini et al. [46] | Canada | Identified from Community Mental Health Programme. Majority lived supported accommodation. | RCT | Volunteers | 13 | 13 | Participants – eligibility criteria specified - yes |
- standardised diagnostic criteria -yes | |||||||
- non-random recruitment | |||||||
- similar baseline groups – | |||||||
Intervention – details of therapists training not indicated | |||||||
- no treatment manual | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded to treatment allocation | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation - yes | |||||||
allocation concealment - yes | |||||||
blinding of participants, personnel and outcome assessors - unclear | |||||||
incomplete data outcome - no | |||||||
free of selective outcome reporting - yes | |||||||
free of other sources of bias - yes | |||||||
Small sample, participants supported accommodation. Inclusion criteria – patients had to have one or more cardiovascular risk factors. | |||||||
Beebe et al. [43] | USA | Outpatients | RCT | Volunteers | 97 | 79 | Participants – eligibility criteria specified |
- standardised diagnostic criteria | |||||||
- non-random recruitment | |||||||
- similar baseline groups | |||||||
Intervention – details of therapists training indicated | |||||||
- treatment manual - yes | |||||||
- compliance of medication non- not checked | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded to treatment allocation | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation - yes | |||||||
allocation concealment - unclear | |||||||
blinding of participants, personnel and outcome assessors - unclear | |||||||
incomplete data outcome - unclear | |||||||
free of selective outcome reporting - yes | |||||||
free of other sources of bias - yes | |||||||
Well-designed programme. Adequate sample size. | |||||||
No assessment of mental health changes - improvement in mental health may have contributed to increase in exercise by itself. | |||||||
Methapatara et al. [44] | Thailand | Inpatient & Outpatients | RCT | Volunteers | 64 | 64 | Participants – eligibility criteria specified |
- standardised diagnostic criteria – not indicated | |||||||
- volunteers | |||||||
- dissimilar baseline groups – | |||||||
younger control population | |||||||
Intervention – details of therapists training not indicated | |||||||
- treatment manual - no | |||||||
- compliance of medication not checked | |||||||
Measurement of Outcome | |||||||
- outcome assessors blinded to treatment allocation | |||||||
- adequate follow- up period | |||||||
Risk of Bias - adequate sequence generation - yes | |||||||
allocation concealment - yes | |||||||
blinding of participants, personnel and outcome assessors - no | |||||||
incomplete data outcome - yes | |||||||
free of selective outcome reporting - yes | |||||||
free of other sources of bias - yes | |||||||
Small sample size, no record of daily steps recorded or measurement of change in exercise levels. Compliance with programme unknown (as no recording of pedometer). No assessment of nutritional intake which may have affected outcome. Effect on mental health unknown. | |||||||
Scheewe et al. [42] | USA | Community | RCT | Volunteers | 118 | 92 | Participants – eligibility criteria specified - yes |
- standardised diagnostic criteria – not indicated | |||||||
- non-random recruitment | |||||||
- dissimilar baseline groups | |||||||
Intervention – details of therapists training indicated | |||||||
- treatment manual | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded to treatment allocation | |||||||
- adequate follow-up period | |||||||
Risk of Bias - adequate sequence generation - yes | |||||||
allocation concealment - yes | |||||||
blinding of participants, personnel and outcome assessors - no | |||||||
incomplete data outcome - unclear | |||||||
free of selective outcome reporting - yes | |||||||
free of other sources of bias - yes | |||||||
Well-designed programme. Large sample size. Computer generated randomisation. Study part of larger research trials. No results from mental health assessment. Baseline group differences. Mean weight greater in patients than controls. Motivated group of patients with higher level of fitness at baseline. No follow up of participants to show whether improvement in exercise maintained. | |||||||
Pelham et al. [48] | USA | Community Rehabilitat-ion | RCT | Volunteers | 10 | 10 | Participants – eligibility criteria specified - yes |
- standardised diagnostic criteria – not indicated | |||||||
- non-random recruitment | |||||||
- baseline groups unclear | |||||||
Intervention – details of therapists training indicated - no | |||||||
- treatment manual- no | |||||||
Measurement of Outcome | |||||||
- outcome assessors not blinded to treatment allocation | |||||||
- adequate follow-up period | |||||||
Risk of Bias - adequate sequence generation - unclear | |||||||
allocation concealment - unclear | |||||||
blinding of participants, personnel and outcome assessors - no | |||||||
incomplete data outcome - unclear | |||||||
free of selective outcome reporting - unclear | |||||||
free of other sources of bias – unclear | |||||||
Small study. Control also using exercise activity. Data not available to include in meta-analysis. Early study 21 years ago. Beneficial effects on exercise fitness and depression scores. |
Study | Results | Comments/Analysis |
---|---|---|
Beebe et al. [41] | 6-Minute Walking Distance (MWD) – improvement in distance clinically (152.5 mins) compared with the control group (56.7 mins), but not statistically significant. BMI and body fat reduced in intervention group compared with the control group but not statistically significant. Control Group – increased 6- MWD during intervention (5%). | Valuable study, limited by small sample, population type. Control group showed some increase in physical activity (? overlap effect of intervention). |
Skrinar et al. [45] | Weight change intervention: control -2.2 v. -1.2 kg (non-significant). Exercise intensity increased in intervention compared with the control + 8 Watts v. -5 Watts (non-significant). Significant improvement in results in general health (p < 0.05) and empowerment (p < 0.01). | Valuable study although some limitations in methodology. |
Acil et al. [47] | Exercise programme resulted in decrease in psychiatric symptoms and increase in quality of life. Reduced SANS, SAPS and BSI. Increase in WHOQOL-BREF-TR. No exercise measures change of heart rate. Demographic data not provided. | Valuable intervention study, however limited by small sample size, and lack of standardization of intervention. No details of drop-out rate or measurement of exercise levels in subjects. |
Marzolini et al. [46] | Mean age 43 years. Exercise group showed a 27.7 metre (SD ± 22.3 m) increase in 6MWD while control group showed decrease of 28.3 metres (SD ± 26.6 m) (between group difference, p = 0.1). There was significant increase in strength exercise and Mental Health Inventory. Attendance averaged 72% (SD ± 4.4%) with no dropouts. | Valuable study but limited by small sample size. Good adherence to programme. |
Beebe et al. [43] | Percentage attendance in WALC-S group 35.2 versus 27.3% after 16 week programme. 33.7 versus 22.9 in TAC group. Greater persistence in weeks in WALC-S versus TAC, and higher minutes walked (76.67 versus 116.89) in WALC-S group, and (61.88 versus 788.83) in TAC group. | Well-designed study indicating the benefit of exercise advice with a motivational programme in addition to exercise intervention. |
Methapatara et al. [44] | End of programme, mean body weight decreased significantly compared with the control group by 2.21 kg (p = 0.03). | Valuable study showing the benefit of an exercise programme in overweight or obese patients with schizophrenia. |
Scheewe et al. [42] | Patients had higher resting HR, lower pear HR, peak systolic BP, relative VO2 peak, Wpeak, RER, minute ventilation, and HR recovery than controls. In conclusion patients had lower CRF levels compared with controls. Exercise therapy increased VO2 peak, and Wpeak in patients and controls. VO2 peak, and Wpeak decreased in non-exercising patients. | Well-designed study. Results show an increase in CRF in individuals with schizophrenia. However individuals may be more motivated and have greater baseline fitness than many individuals with this illness. |
Trend-level effect on depressive symptoms (p = 0.07). No effect on symptoms of schizophrenia. | ||
Significantly smaller baseline cerebral (gray) matter, and larger third ventricle volume, thinner cortex. NO change global brain, hippocampal volume, or cortical thickness. | ||
Pelham et al. [48] | Aerobic exercise group showed significant increases in fitness and a reduction in depression scores. Non-aerobic groups did not improve in fitness level or level of depression. | Small study of 10 patients. Conducted 21 years ago. Findings showed the possible positive effects of exercise on levels of fitness and mental health in people with serious mental illness. |
Setting and participant characteristics
Exercise interventions
Outcomes
Outcome or subgroup title | No. of studies (available data) | No. of participants | Statistical method | Effect Size (SWD) |
---|---|---|---|---|
Exercise activity | 1 | 13 | SMD (IV, Random, 95% CI) | 1.81 [0.44 to 3.18] |
BMI | 4 | 151 | SMD (IV, Random, 95% CI) | -0.24 [-0.56 to 0.08] |
Weight | 2 | 77 | SMD (IV, Random, 95% CI) | 0.13 [-0.32 to 0.58] |
Negative | 2 | 84 | SMD (IV, Random, 95% CI) | -0.54 [-1.79 to 0.71] |
Symptoms | ||||
Positive | 2 | 84 | SMD (IV, Random, 95% CI) | -1.66 [-3.78 to 0.45] |
Symptoms | ||||
Anxiety/Depression | 3 | 94 | SMD (IV, Random, 95% CI) | -0.26 [-0.91 to 0.39] |
Q of L (Physical) | 2 | 30 | SMD (IV, Random, 95% CI) | 0.45 [-0.27 to 1.18] |
Q of L (Mental) | 2 | 30 | SMD (IV, Random, 95% CI) | 0.65 [-0.09 to 1.39] |