Aerobic exercise and yoga improve neurocognitive function in women with early psychosis.
Open accessAbstract
Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types of exercise improved overall and depressive symptoms (all P⩽0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.
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In women experiencing early psychosis, yoga interventions have improved working memory, verbal acquisition, and attention.
“Moreover, in women experiencing early psychosis, yoga interventions have improved working memory, verbal acquisition and attention.66”
In patients with schizophrenia, a 12-week AE intervention has led to increased hippocampal volume, hippocampal NAA concentration, and improved performances on short-term memory and working memory tasks.
“For example, in patients with schizophrenia a 12-week AE intervention has led to increased hippocampal volume, hippocampal NAA concentration and improved performances on short-term memory and working memory tasks (Pajonk et al., 2010; Lin et al., 2015; McEwen et al., 2015).”
From Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment (2016) · cites this paper as Lin et al., 2015
Other forms of exercise such as yoga or weight training may also be beneficial in promoting brain health and cognition.
“Although most of the current literature has focussed on AE, other forms of exercise such as yoga (Lin et al., 2015) or weight training (Suo et al., 2016) may also be beneficial in promoting brain health and cognition.”
From Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment (2016) · cites this paper as Lin et al., 2015
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“As aerobic exercise and cognitive enhancement therapy can prevent the hippocampal volume decreases over time in early psychosis (81, 82), this biotype may be one of the target candidates for prophylactic treatment in the future.”
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MethodYoga versus non-standard care for schizophrenia
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“…symptoms, negative symptoms and working memory (along with other cognitive functions) from exercise, compared to a randomized waitlist control (Lin et al., 2015). r c i Despite these promising findings in FEP groups, it is important to remember that, in each of these studies, the participants…”
BackgroundFox‐Harding, C., Tompsett, C., Sanders, R. H., & Cobley, S. P. (2018) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2018.1519838 · Cited by 14 · see citing works
McGuire, D., Shannon, A., Somaiya, J., Brown, E., & O'Donoghue, B. N. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13151 · Cited by 14 · see citing works
“6 current study were higher compared to the one other study that examined the effects of yoga in FEP by Lin et al which had a 47% attendance rate (11), although it does need to be considered that the study by Lin et al was an RCT with three arms and there attrition would be expected to be higher.”
BackgroundResultTöbelmann, L., Hahne, I., Schulze, T., Bergmann, N., Fuchs, L., Zierhut, M., Hahn, E., & Böge, K. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1086468 · Cited by 13 · see citing works
“Furthermore, several studies show improvements in cognitive deficits in speed indices of attention (41–43), as well as improved working memory (43) in outpatients with SSD following YT versus physical exercise or waitlist control group.”
BackgroundRoell, L., Keeser, D., Papazov, B., Lembeck, M., Papazova, I., Greska, D., Muenz, S., Schneider-Axmann, T., Sykorova, E. B., Thieme, C. E., et al. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad113 · Cited by 12 · see citing works
Roell, L., Fischer, T., Keeser, D., Papazov, B., Lembeck, M., Papazova, I., Greska, D., Muenz, S., Schneider-Axmann, T., Sykorova, E. B., et al. (2024) · Psychological Medicine · doi:10.1017/s0033291724001867 · Cited by 13 · see citing works
“Risk of bias assessment suggested high concerns for three reports including our original data due to high attrition rates (Lin et al., 2015; Scheewe et al., 2013).”
Woodward, M. L., Lin, J., Gicas, K. M., Su, W., Hui, C. L. M., Honer, W. G., Chen, E. Y. H., & Lang, D. J. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.05.043 · Cited by 13 · see citing works
Cognitive remediation in schizophrenia—The view from India
Deshpande, S. N., Triptish Bhatia, A., Mohandas, E., & Nimgaonkar, V. L. (2016) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2016.06.011 · Cited by 13 · see citing works
“A study in Hong Kong also compared effect yoga and aerobic exercise on cognition among women with early psychosis; yoga enhanced attention better than aerobic exercise (Lin et al., 2015).”
BackgroundMayeli, A., Clancy, K. J., Sonnenschein, S. F., Sarpal, D. K., & Ferrarelli, F. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114926 · Cited by 12 · see citing works
Ospina, L., Wall, M., Jarskog, L., Ballon, J. S., McEvoy, J., Bartels, M., Buchsbaum, R., Sloan, R., Stroup, T., & Kimhy, D. (2019) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20190020 · Cited by 12 · see citing works
Physical Health Impairment and Exercise as Medicine in Severe Mental Disorders: A Narrative Review
Brobakken, M. F., Nygård, M., & Wang, E. (2022) · Sports Medicine - Open · doi:10.1186/s40798-022-00490-3 · Cited by 11 · see citing works
“[80] demonstrated that 12 weeks of moderate intensity (60–75% of peak heart rate) endurance treadmill training for 45–60 min, three times a week, resulted in improvements of 2.”
BackgroundTréhout, M., & Dollfus, S. (2018) · L Encéphale · doi:10.1016/j.encep.2018.05.005 · Cited by 12 · see citing works
Mitsadali, I., Grayson, B., Idris, N. F., Watson, L., Burgess, M. A., & Neill, J. C. (2020) · Journal of Psychopharmacology · doi:10.1177/0269881120922963 · Cited by 10 · see citing works
“Aerobic exercise can be beneficial for cognitive function in schizophrenia patients (Falkai et al., 2017; Firth et al., 2017; Lin et al., 2015; Oertel-Knöchel et al., 2014; Pajonk et al., 2010; Subramaniapillai et al., 2016).”
BackgroundSaviola, F., Deste, G., Barlati, S., Vita, A., Gasparotti, R., & Corbo, D. (2023) · Brain Sciences · doi:10.3390/brainsci13060923 · Cited by 10 · see citing works
“Concerning clinical scores, the evidence was found for better overall psych tic symptomatology in schizophrenia [29,30,40,41,46] and for negative symptoms in early psychosis [45] and positive sympt m in high‐risk cohorts [23,24].”
BackgroundResultInfluentialVarambally, S. S., Holla, B., Venkatasubramanian, G., Mullapudi, T., Raj, P., Shivakumar, V., Christopher, R., Debnath, M., Philip, M., Bharath, R. D., et al. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.05.007 · Cited by 10 · see citing works
Physical Health in Clinical High Risk for Psychosis Individuals: A Cross-Sectional Study
Provenzani, U., Micheli, A. D., Damiani, S., Oliver, D., Brondino, N., & Fusar‐Poli, P. (2023) · Brain Sciences · doi:10.3390/brainsci13010128 · Cited by 9 · see citing works
“, mood, anxiety and substance use disorders) [23], which are also linked to a significant reduction in daily functioning and physical health [24,25] related to these disorders.”
BackgroundYoga as part of a package of care versus non-standard care for schizophrenia
Broderick, J. M., & Vancampfort, D. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012807.pub2 · Cited by 9 · see citing works
Triptish Bhatia, A., Kumari, N., Yadav, A., Beniwal, R. P., Shah, G., Joel, W., Jones, J. R., Iyenger, S., Nimgaonkar, V. L., & Deshpande, S. N. (2022) · Acta Neuropsychiatrica · doi:10.1017/neu.2022.14 · Cited by 8 · see citing works
Rampino, A., Falcone, R. M., Giannuzzi, A., Masellis, R., Antonucci, L. A., & Torretta, S. (2021) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902117010031 · Cited by 8 · see citing works
Leroux, E., Tréhout, M., Reboursière, E., de Flores, R., Morello, R., Guillin, O., Quarck, G., & Dollfus, S. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01818-8 · Cited by 7 · see citing works
Kim, D. D., Barr, A. M., Honer, W. G., & Procyshyn, R. M. (2018) · Molecular Psychiatry · doi:10.1038/s41380-018-0022-8 · Cited by 8 · see citing works
“Conflicting results as to the effects of aerobic exercise on HV are also present among individuals in the early stages of illness [6, 7].”
BackgroundChen, C.-R., Lee, Y.-W., Chen, T., Hsu, C., Huang, Y., Lin, P., & Lin, K. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.07.042 · Cited by 7 · see citing works
“Six studies used an exercise control group, five studies applied aerobic exercise (Behere et al., 2011; Bhatia et al., 2017; Chen et al., 2022; Li et al., 2020; Lin et al., 2015), and one combined aerobic exercise and resistance training (Ho et al., 2016).”
BackgroundMethodInfluentialBrowne, J., Cather, C., Zvonar, V., Thayer, K., Skiest, H. E., Arntz, D., Kritikos, K. I., Schnitzer, K., Brown, H., Evins, A., et al. (2020) · Community mental health journal · doi:10.1007/s10597-020-00655-y · Cited by 7 · see citing works
“2016), and are associated with less severe overall, general, negative, and depressive symptoms, and improved working memory (Lin et al. 2015; Firth et al. 2018).”
BackgroundHeggelund, J., Vancampfort, D., Tacchi, M. J., Morken, G., & Scott, J. L. (2019) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13119 · Cited by 7 · see citing works
Fouhy, F., Cullen, W., & O’Connor, K. (2020) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2020.92 · Cited by 7 · see citing works
“Five were carried out in the UK, four in Australia, two in Sweden and one in each of Italy, New Zealand, Denmark, Hong Kong and Canada.”
BackgroundMethodResultInfluentialMartin, S. S., Monica, C. L., Soto, L., & Latocha, V. (2024) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2024.103073 · Cited by 6 · see citing works
Semler, E., Herpich, F., Zellner, L., Zwick, S., Zwanzger, P., & Brunnauer, A. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01773-4 · Cited by 6 · see citing works
“Interestingly, Ho and colleagues [29] as well as Lin et al. [43] demonstrated a beneficial effect on short-term memory due to an exercise program, too.”
InfluentialPhysical activity interventions to improve cognition in first-episode psychosis: What we know so far
Perlini, C., Rossetti, M. G., Girelli, F., & Bellani, M. (2024) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1792 · Cited by 5 · see citing works
A pilot study of a mindfulness informed yoga intervention in young people with psychosis
O'Dea, D., Curtis, J., Scully, A., & Lappin, J. (2022) · Early Intervention in Psychiatry · doi:10.1111/eip.13264 · Cited by 5 · see citing works
“An RCT compared a 12-week yoga and aerobic exercise program to determine its impact on neurocognitive function in 124 adult women aged 16–60 years with early psychosis (Lin et al., 2015).”
BackgroundMethodResultInfluentialImpact of Non-pharmacological Interventions on Brain Structure and Function in Schizophrenia
Hegde, R. R., Kelly, S., Guimond, S., & Keshavan, M. S. (2020) · Springer eBooks · doi:10.1007/978-3-030-35206-6_20 · Cited by 4 · see citing works
Exercise for Adolescents and Young People With Mental Illness
Parker, A. G., & Bailey, A. P. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-812605-9.00008-3 · Cited by 5 · see citing works
Yoga for Schizophrenia: a Review of Efficacy and Neurobiology
Dodell-Feder, D., Gates, A., Anthony, D., & Agarkar, S. (2017) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-017-0125-6 · Cited by 7 · see citing works
Wang, Z., Li, J., Wang, L., & Wei, Q. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116665 · Cited by 4 · see citing works
Hahne, I., Zierhut, M., Bergmann, N., Hahn, E., Ta, T. M. T., Calvano, C., Bajbouj, M., & Böge, K. (2026) · Schizophrenia Bulletin · doi:10.1093/schbul/sbae198 · Cited by 4 · see citing works
Javelle, F., Suhrkamp, J., Wählen, L., Donath, L., & Bloch, W. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121386 · Cited by 3 · see citing works
Effect of yoga practice on cognitive functions among the patients of depression
Kumari, N., Gupta, I. D., Jeph, D., Yadav, A., Yadav, K., Garg, N., Goothy, S. S. K., & Choudhary, A. (2023) · Asian Journal of Medical Sciences · doi:10.3126/ajms.v14i2.49467 · Cited by 3 · see citing works
Roell, L., & Maurus, I. (2023) · doi:10.31219/osf.io/y2phs · Cited by 3 · see citing works
Yoga for Mental Health Disorders
Bhargav, H., Arasappa, R., Inbaraj, G., Udupa, K., & Varambally, S. S. (2020) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-7998-3254-6.ch011 · Cited by 2 · see citing works
Physical activity for young people with mental illness
Pascoe, M. C., & Parker, A. G. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-89843-0.00002-7 · Cited by 2 · see citing works
Grossman, N. (2019) · ScholarlyCommons (University of Pennsylvania) · Cited by 2 · see citing works
A literature review on behavioral attributes of yoga postures and cognition
Gupta, A., & Gupta, R. K. (2021) · Yoga Mimamsa · doi:10.4103/ym.ym_62_21 · Cited by 2 · see citing works
Schwartz, B. L., Teslovich, T., You, X., Cho, J., Schooler, N. R., Kokkinos, P. F., & Vaidya, C. J. (2018) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.scwo.061518 · Cited by 2 · see citing works
Yoga as A Complementary Therapeutic Modality for People with Alzheimer’s Disease: A Review
Ghaffari, M. (2019) · Journal of Yoga and Physiotherapy · doi:10.19080/jyp.2019.08.555740 · Cited by 2 · see citing works
The engagement of psychology with complementary medicine: A critical integrative review
Thomson-Casey, C., Adams, J., & McIntyre, E. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e21201 · Cited by 1 · see citing works
“For example, research has demonstrated the efficacy of yoga to address stress symptoms [37], early psychosis [38], anxiety [39], depression [40], and eating disorders [41].”
BackgroundVentura, J., Roell, L., Maurus, I., & Firth, J. (2026) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgag006 · Cited by 1 · see citing works
Physical Activity and Women’s Mental Health
Gomes, E., Costa, R., Bastos, T. C. L., Probst, M., & Corredeira, R. (2018) · Lecture notes in computational vision and biomechanics · doi:10.1007/978-3-319-71574-2_2 · Cited by 1 · see citing works
Woodward, M. L., Ker, A. H., Barr, A. M., Beasley, C. L., Hercher, C., Boyda, H. N., Procyshyn, R. M., Honer, W. G., & Lang, D. J. (2019) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2019.172834 · Cited by 1 · see citing works
Kaligal, C., Kanthi, A., Mahadevappa, V., & Singh, D. (2023) · Integrative and Complementary Therapies · doi:10.1089/ict.2023.29061.cka · Cited by 1 · see citing works
“Two studies 20,23 had a PEDro score of 9, indicative of excellent quality, eight studies 17,19,21,22,24–27 had scores in the range of 6 to 8, indicative of good quality, and two 18,28 were of fair quality with scores ranging from 4 to 5.”
Evaluating a pilot community-based FITMIND exercise programme for psychosis in Hong Kong
Suen, Y. N., Lee, E. H. M., Lam, C. O. B., Hui, C. L. M., Chan, S. K. W., Chang, W. C., & Chen, E. Y. H. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04901-x · Cited by 1 · see citing works
“Particularly, previous studies found that aerobic exercise and yoga, in conjunction with an increase in hippocampal volume [18], were associated with improvements in both working memory and depressive symptoms, and yoga can additionally improve verbal acquisition and attention [19].”
BackgroundResultLópez-Moral, Á., Munguía‐Izquierdo, D., & Bueno‐Antequera, J. (2023) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-6684-6040-5.ch008 · Cited by 1 · see citing works
The effect of super brain yoga on the cognitive function of hemodialysis patients
Babakhani, M., Rahzani, K., Hekmatpou, D., & Sheykh, V. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e36384 · Cited by 1 · see citing works
Comparison of Hatha Yoga and Elderly Exercise in Quality of Life in Elderly
Santoso, R., Kesoema, T. A., & Dewi, N. S. (2025) · Surabaya Physical Medicine and Rehabilitation Journal · doi:10.20473/spmrj.v7i1.57685 · Cited by 1 · see citing works
Yoga practice and the preservation of mental health: The global and national perspectives
Tešović, I. (2019) · Socioloski pregled · doi:10.5937/socpreg53-20346 · Cited by 1 · see citing works
Yoga and Outcome of Schizophrenia
Rao, N. P., Shivakumar, V., & Gangadhar, B. N. (2020) · Springer eBooks · doi:10.1007/978-3-030-19847-3_23 · Cited by 1 · see citing works
The latest in dementia prevention: A review of the promising role of aerobic exercise
Shigemori, K. (2016) · Journal of allied health sciences · doi:10.15563/jalliedhealthsci.7.37
- Authors
- Lin, J., Chan, S. K., Lee, E. H., Chang, W. C., Tse, M., Su, W. W., Sham, P., Hui, C. L., Joe, G., Chan, C. L., Khong, P. L., So, K. F., Honer, W. G., & Chen, E. Y.
- Affiliations
- University of Hong Kong (HK)
- University of British Columbia (CA)
- ORCID
- Venue
- npj Schizophrenia
- Published
- 2015-12-02
- Volume
- 1
- Issue
- 1
- Pages
- 15047-15047
- ISSN
- 2334-265X (ISSN-L)
- PMC
- PMC4849465
- OpenAlex
- W2284293060
- Cited by
- 118
- References
- 23
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 15 · 2023: 12 · 2022: 12 · 2021: 10 · 2020: 19 · 2019: 10 · 2018: 13 · 2017: 8 · 2016: 7 · 2015: 1
- FWCI
- 7.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Schizophrenia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Hong Kong (C00240, 762412, 201007176229)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- early psychosis, yoga, aerobic exercise, neurocognitive function, working memory, attention, depressive symptoms, psychotic symptoms, hippocampal volume, women, adjunctive therapy
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