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Cited by 120Schizophrenia research and treatmentAdvanced Neuroimaging Techniques and ApplicationsPhysical Activity and Health

Physical exercise keeps the brain connected: biking increases white matter integrity in patients with schizophrenia and healthy controls.

Open access
Svatkova, Alena, Mandl, René C.W., Scheewe, Thomas W., Cahn, Wiepke, Kahn, René S., Hulshoff Pol, Hilleke E.·2015·Schizophrenia Bulletin
DOI 10.1093/schbul/sbv033PMC PMC4466190
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Abstract

It has been shown that learning a new skill leads to structural changes in the brain. However, it is unclear whether it is the acquisition or continuous practicing of the skill that causes this effect and whether brain connectivity of patients with schizophrenia can benefit from such practice. We examined the effect of 6 months exercise on a stationary bicycle on the brain in patients with schizophrenia and healthy controls. Biking is an endemic skill in the Netherlands and thus offers an ideal situation to disentangle the effects of learning vs practice. The 33 participating patients with schizophrenia and 48 healthy individuals were assigned to either one of two conditions, ie, physical exercise or life-as-usual, balanced for diagnosis. Diffusion tensor imaging brain scans were made prior to and after intervention. We demonstrate that irrespective of diagnosis regular physical exercise of an overlearned skill, such as bicycling, significantly increases the integrity, especially of motor functioning related, white matter fiber tracts whereas life-as-usual leads to a decrease in fiber integrity. Our findings imply that exercise of an overlearned physical skill improves brain connectivity in patients and healthy individuals. This has important implications for understanding the effect of fitness programs on the brain in both healthy subjects and patients with schizophrenia. Moreover, the outcome may even apply to the nonphysical realm.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 6-month intervention, regular stationary biking increased white matter integrity (fractional anisotropy) in motor-related tracts in both patients with schizophrenia and healthy controls, whereas life-as-usual decreased FA in the same clusters. Patients and controls benefited similarly, and fitness gains correlated with FA increases.

Key findings

  • Exercise versus life-as-usual produced significant FA increases in the exercise group in the left corticospinal tract, left superior longitudinal fascicle, left inferior longitudinal fascicle, left inferior fronto-occipital fascicle, left anterior thalamic radiation, and body/splenium of the corpus callosum (p FWEcorr < 0.05); the life-as-usual group showed FA decreases in these same clusters.
  • No significant differences in plasticity between patients and controls were found; both groups benefited equally from exercise.
  • JHU-atlas ROI analysis showed time-by-randomization FA increases in the left CST (F = 4.15, P = .045), left SLF (F = 5.092, P = .027), and forceps major (F = 5.687, P = .02), but after correction for 14 ROIs (threshold .0035) these did not reach corrected significance.
  • Correlations: change in Wpeak correlated with dFA skeleton (r = .246, P = .028) and dFA picked (r = .374, P = .001); dVO2peak correlated with dFA skeleton (r = 0.270, P = .016); in patients, decrease in positive symptoms correlated with FA improvement (r = -0.455, P = .008).

Methods

  • TOPFIT cohort: 33 patients with schizophrenia and 48 healthy controls, aged 18–48 years, physically inactive, randomized 1:1 (stratified by gender, recruitment site, BMI) to 6 months of physical exercise or life-as-usual/occupational therapy; exercise was 1 h twice weekly (40 min aerobic, 20 min anaerobic), with biking about 50% of the duration.
  • DTI brain scans at 3 Tesla before and after intervention; whole-brain tract-based spatial statistics (TBSS) and JHU-ICBM atlas ROI analysis of fractional anisotropy.
  • Longitudinal analyses used GLM with time, randomization, group, and compliance as covariate; TBSS used 5000 permutations with threshold-free cluster enhancement; correlations examined FA changes with cardiorespiratory fitness, BMI, IQ, PANSS, and chlorpromazine equivalents.

Limitations

  • Stated in the paper: patient exercise adherence is problematic due to poor motivation, medication side effects, social barriers, and symptoms; no significant baseline FA differences were found between patients and controls, so findings may not extend to patients with more severe white matter abnormalities; antipsychotic medication influence was considered but no significant correlation with FA was found; ongoing exercise may be necessary to maintain FA effects, raising motivation concerns; mechanisms remain unclear.
  • Evident from the text: the ROI findings did not survive correction for multiple comparisons across 14 ROIs; compliance differed significantly between exercise and nonexercise groups and between patients and controls, although compliance was included as a covariate.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/schbul/sbv033

Cites

84 of 84 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 58 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Physical Exercise Keeps the Brain Connected: Biking Increases White Matter Integrity in Patients With Schizophrenia and Healthy Controls

    Life-as-usual leads to a decrease in white matter fiber integrity in the same clusters over 6 months.

    “whereas life-as-usual leads to a decrease in fiber integrity.”
    • Also stated in: § Following the Intervention · plain
      “Decreases in FA in these same clusters were found in the life-as-usual group.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Discussion

    FA increased between baseline and follow-up in the exercise group compared with decreases in the nonexercise group.

    “FA increases between baseline and follow-up in exercise group comparing to decreases of FA in nonexercise group.”
    Quote in the paperSubstantial claim
  • Findingown data
    § FA with Cardiovascular Fitness, Oxygen Uptake, BMI, and IQ

    In the exercise group compared with the nonexercise group, local FA values increased in several white matter clusters (TFCE, P FWEcorr < .05).

    “Local statistical maxima of FA values increases in exercise group comparing to nonexercise group (clusters with P FWEcorr &lt; .05) MNI coordinates showing the location of the maximum intensity voxel of each cluster.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Discussion

    Continuous exercise predominantly affects white matter in the left hemisphere specifically in right-handed individuals.

    “Interestingly, the continuous exercise predominantly affects white matter in the left hemisphere specifically in right-handed individuals (for details see supplementary data).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Discussion

    The study has not shown direct evidence of improvement in cognitive functions based on specific psychological tests.

    “even though our study has not shown direct evidence of improvement in cognitive functions based on specific psychological tests.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 31

  • May combine two claims.

    Findingown data
    § Physical Exercise Keeps the Brain Connected: Biking Increases White Matter Integrity in Patients With Schizophrenia and Healthy Controls

    Regular physical exercise of an overlearned skill (bicycling) for 6 months significantly increases white matter fiber integrity, especially in motor-functioning-related tracts, in patients with schizophrenia and healthy controls, irrespective of diagnosis.

    “We demonstrate that irrespective of diagnosis regular physical exercise of an overlearned skill, such as bicycling, significantly increases the integrity, especially of motor functioning related, white matter fiber tracts whereas life-as-usual leads to a decrease in fiber integrity.”
    • Also stated in: § Following the Intervention · plain
      “Clusters with significant increases in FA between the first and second measurement were found in the exercise group in the left corticospinal tract (LCST), the left superior longitudinal fascicle (LSLF), the left inferior longitudinal fascicle (LILF), the left inferior fronto-occipital fascicle (LIFOF), left anterior thalamic radiation (ATR) and in the body and splenium of the”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § FA with Cardiovascular Fitness, Oxygen Uptake, BMI, and IQ

    There were no significant associations of FA or change in FA with BMI, resting HR, max HR, or IQ in both groups, or with overall PANSS, PANSS negative, PANSS disorganized, PANSS excited, PANSS emotional, or ChE dose in patients.

    “There were no significant associations of FA or change in FA with BMI, HR rest , HR max , IQ in both groups and with overall PANSS, PANSS neg , PANSS dis , PANSS exc , PANSS emo , or ChE dose in the patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Baseline

    No significant difference in FA was detected between patients and controls at baseline using cluster-based and JHU-ICBM-atlas-based approaches, although mean whole-skeleton FA was lower in patients (0.420) than controls (0.422).

    “Despite the differences measured between patients and controls in clinical characteristics, no significant difference in FA was detected using cluster-based and JHU-ICBM-atlasbased approaches, although mean FA value calculated for whole skeleton was lower in patients (mean = 0.420, SD = 0.017) than in controls (mean = 0.422, SD = 0.013).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Following the Intervention

    In patients, the exercise group showed decreases in overall PANSS score, positive symptoms, excitement score, and disorganization score, contrary to increases in the nonexercise group.

    “Significant differences in the exercise and nonexercise group from the first to second measurement (time by randomization) were found in the cardiorespiratory fitness parameters (W peak , VO 2peak ), and in PANSS scores decreases in overall PANSS score, positive symptoms, excitement score, and disorganization score in exercise group of patients, contrary to increases in”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Following the Intervention

    In JHU-atlas-based ROI analysis, significant increases in FA over time were found in exercise vs nonexercise in LCST (F=4.15, P=.045), LSLF (F=5.092, P=.027), and FM (F=5.687, P=.02) in both patients and controls, but these did not reach significance after correction for 14 ROIs (threshold .0035).

    “Repeating the analysis with the JHU-atlas-based ROI analysis, significant increases in FA were found over time in the exercise group as compared to the nonexercise group (time by randomization) in the LCST ( F = 4.15, P = .045), the LSLF ( F = 5.092, P = .027) and FM ( F = 5.687, P = 0.02) in both patients and controls (figure 2; table 3), but after the correction for”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    Alleviation of positive symptoms and increasing white matter integrity seemed to go hand-in-hand in patients.

    “specifically, alleviation of positive symptoms and increasing white matter integrity seemed to go hand-in-hand.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § FA with Cardiovascular Fitness, Oxygen Uptake, BMI, and IQ

    For VO2peak, a significant correlation was demonstrated only for the difference in overall FA values (r=0.270, P=.016), not for the FA difference in clusters showing longitudinal FA increase.

    “For the maximal oxygen uptake measurement (ie, VO 2peak ), a significant correlation was demonstrated only for the difference in overall FA values (dFA skeleton ) ( r = 0.270, P = .016), and not for the FA difference in clusters showing longitudinal FA increase (dFA picked ).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Increases in cortical and hippocampal volume were found after periods of exercise in healthy individuals.

    “Increases in the volume of the cortex 14-16,18 and hippocampus 17,19 were found after periods of exercise in healthy individuals.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
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    Premisecitation
    § Introduction

    Some studies did not find significant effects of exercise on cortical architecture.

    “However, others did not find significant effect, eg, on cortical architecture. 20-22”
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    • cites [22] Gondoh, 2009, Effects of aerobic exercise training on brain structure and psychological well-being in young adults, J Sports Med Phys Fitness

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    In healthy students, learning a new skill such as juggling increases gray matter volume and improves white matter integrity.

    “In healthy students, it has been shown that when a new skill is learned, such as juggling, gray matter volume increases 14 and white matter integrity improves. 23”
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    Premisecitation
    § Introduction

    Some schizophrenia-related changes in gray and white matter are progressive in nature.

    “Moreover, some of the schizophreniarelated changes in gray 8,9 and white matter 10 are progressive in nature.”
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    Premisecitation
    § Introduction

    After acquiring proficiency in juggling, brain changes reverted to normal after 3 months without practice, suggesting practice rather than acquisition affects the brain.

    “After having acquired proficiency in juggling, the changes in the brain reverted to normal after the students had stopped practicing for 3 months, suggesting it may be practice rather than acquisition that affects the brain.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

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    Premisecitation
    § Introduction

    After training a complicated balancing act, white matter changes remained present.

    “On the other hand, after training a complicated balancing act, white matter changes remained present. 23”
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    Premisecitation
    § Introduction

    Progressive brain tissue loss in schizophrenia has been associated with genetic factors, disease-related factors, and antipsychotic medication intake.

    “The (progressive) brain tissue loss has been associated with genetic factors and with disease-related factors 11,12 as well as effects of antipsychotic medication intake. 13”
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    Premisecitation
    § Introduction

    Physical exercise affects gray matter structure.

    “Physical exercise has been reported to affect gray matter structure. 14-19”
    Quote in the paperNot a substantial claim0 of 6 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    In patients with schizophrenia, one study found hippocampal volume increase after exercise training, but other studies did not find increases in hippocampal volume or cortical density.

    “In patients with schizophrenia, a period of exercise training resulted in hippocampal volume increase in one study 19 but other studies did not reveal increases in hippocampal volume 20 or cortical density. 18”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Baseline

    Significant differences in compliance between exercise and nonexercise groups and between patients and controls were found.

    “Significant differences in compliance between exercise and nonexercise group and patients vs controls were found.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Cohort

    No significant differences were found between patients and controls in mean age, gender, handedness, and parental level of education.

    “No significant differences were found between patients and controls in mean age, gender, handedness, and parental level of education.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Discussion

    The CST represents the major fiber bundle for motor functioning, transferring information from multiple cortical areas to the brain stem and spinal cord.

    “The CST represents the major fiber bundle for motor functioning, transferring information from multiple cortical areas to the brain stem and spinal cord. 51”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • May combine two claims.

    Study design and conductown data
    § Baseline

    No significant baseline difference between the exercise group and nonexercise group was found in heart rate in rest, peak work rate, highest oxygen uptake, and IQ.

    “No significant baseline difference between the exercise group and nonexercise group was found in heart rate in rest (HR rest ), peak work rate at the moment of exhaustion (W peak in Watt), highest oxygen uptake during the last 30 s of the test (VO 2 in ml/kg/min), and IQ (table 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Higher FA is associated with better functional connectivity between anatomically distant gray matter regions using resting-state fMRI.

    “higher FA has been associated with better functional connectivity between anatomically distant gray matter regions using resting-state fMRI (functional MRI) 35,47,48”
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    Premisecitation
    § Discussion

    The SLF is a major association fiber bundle involved in higher aspects of motor behavior such as coding of body parts in the surrounding space and monitoring competing motor actions.

    “The SLF is a major association fiber bundle involved in higher aspects of motor behavior such as coding of body parts in the surrounding space and monitoring (competing) motor actions. 54”
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    Study design and conductnone given
    § Intervention

    A research assistant and a sport physician assessed baseline and follow-up measurements while blind to randomization.

    “A research assistant and a sport physician assessed the demographic and clinical baseline and follow-up measurements while being blind to the randomization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Higher FA is related to interhemispheric transition time measured with event-related potentials (ERP) and quantitative electroencephalography (EEG).

    “Moreover, a higher FA has been related to interhemispheric transition time measured with event-related potentials (ERP) 45 and quantitative electroencephalography (EEG). 46”
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    • cites [46] Scrascia, 2014, Relationship among diffusion tensor imaging, EEG activity, and cognitive status in mild cognitive impairment and Alzheimer’s disease patients, J Alzheimers Dis source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Cross-sectional studies mainly in musicians suggest that early practice determines brain changes; practice time correlates with degree of brain change, not skill per se.

    “Interestingly, several cross-sectional studies, mainly conducted in musicians, suggest that it is (early) practice that determines changes in the brain 24 : proficiency-expressed as practice time-is generally correlated with the degree of brain change, not with the skill of playing the instrument per se. 25”
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    • cites [25] Gärtner, 2013, Brain morphometry shows effects of long-term musical practice in middle-aged keyboard players, Front Psychol source

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    Study design and conductown data
    § Following the Intervention

    Results were corrected for family-wise error (FWEcorr).

    “These results were corrected for Family-wise error (FWEcorr) (for additional information see supplementary data).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    These findings may extend to the nonphysical realm.

    “these findings may also extend to the nonphysical realm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Better functional connectivity is associated with higher cognitive functioning.

    “better functional connectivity has been associated with higher cognitive functioning, 49,50”
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    Study design and conductown data
    § Cohort

    Randomization was performed as a computer-generated procedure with concealed allocation (ratio 1:1), stratified for gender, recruitment site, and Body Mass Index.

    “Randomization was performed as a computer-generated procedure, incorporating a concealed allocation (ratio 1:1), with stratification for gender, recruitment site and Body Mass Index.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    85% of the Dutch owns a bicycle and each year travels 900 km on it.

    “Indeed, 85% of the Dutch owns a bicycle and each year travels 900 km on it. 26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

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    Premisecitation
    § Discussion

    Maturation of the CST is driven by neural activity in cortical motor areas and limb experience, reflecting the need to adapt to changing motor demands.

    “Both rodent and human studies suggest that maturation of the CST is driven by neural activity in cortical motor areas and limb experience, thus reflecting the need to adapt to changing motor demands. 52,53”
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    Premisecitation
    § Discussion

    The ILF, IFOF, and ATR are involved in attention, visual processing, verbal processing and language functions, face recognition, executive functioning, and memory encoding.

    “All aforementioned tracts are involved in attention, visual processing, verbal processing and language functions, and face recognition 61 as well as executive functioning and memory encoding, 62”
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    Study design and conductown data
    § Intervention

    Compliance was over 50% in the subjects included in the study.

    “Compliance was registered as a percentage of sessions attended and was over 50% in the subjects included in the study (for details see supplementary data).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Baseline

    At baseline, patients and controls differed significantly in heart rate in rest, maximal heart rate, peak work rate, and IQ, but not in highest oxygen uptake.

    “At baseline, a significant difference was found between the patients and the controls, irrespective of intervention condition, in heart rate in rest (HR rest ), maximal heart rate (HR max ), together with difference in peak work rate at the moment of exhaustion (W peak in Watt) as a measure of cardiorespiratory fitness, although no significant difference in the highest oxygen uptake during”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Cohort

    Body mass index was significantly higher in patients compared to healthy subjects.

    “Body mass index (BMI) was significantly higher in patients as compared to healthy subjects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    A positive influence of antipsychotic medication on glia cells and myelination has been demonstrated.

    “A positive influence of antipsychotic medication on glia cells and myelination has been demonstrated. 82,83”
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    Interpretationreasoning
    § Discussion

    These associations imply that changes are caused by practice of an overlearned aerobic activity rather than anaerobic newly learned exercise.

    “Moreover, these associations imply that changes are caused by practice of an overlearned aerobic activity rather than anaerobic newly learned exercise.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Biking is an overlearned physical skill.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    We cannot predict how our findings will extend to patients with more severe white matter abnormalities, either through more or less prominent improvements in fiber integrity.

    “Therefore we cannot predict how our findings will extend to patients with more severe white matter abnormalities, either through more or less prominent improvements in fiber integrity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data
    § Discussion

    The effect in white matter may be due to improvements in cardiorespiratory fitness, as suggested by positive associations between FA and cardiorespiratory fitness parameters over time.

    “Alternatively, the effect in white matter may be due to improvements in cardiorespiratory fitness, as suggested by positive associations between FA and cardiorespiratory fitness parameters over time.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § Discussion

    The study used a randomized design with exercise and nonexercise groups.

    “two randomization groups (exercise vs nonexercise)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Discussion

    In patients, implementation and sustainability of regular exercise commitment remains problematic due to poor motivation, side effects of medications, social barriers, and symptoms.

    “In patients implementation and sustainability of regular exercise commitment remains problematic due to poor motivation, 73 side effects of medications, 74,75 social barriers, 76 and symptoms. 73”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [73] Archie, 2003, Pilot study: access to fitness facility and exercise levels in olanzapine-treated patients, Can J Psychiatry source

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    • cites [74] source

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    • cites [75] Newcomer, 2006, The metabolic effects of antipsychotic medications, Can J Psychiatry source

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    Premisecitation
    § Discussion

    A growing body of evidence suggests possibly direct contributions of activation of fiber bundles to changes in white matter.

    “A growing body of evidence suggests possibly direct contributions of activation of fiber bundles to changes in white matter. 84”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Mandl, 2013, Functional diffusion tensor imaging at 3 Tesla, Front Hum Neurosci source

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42 of 42

  • The paper relies on this without support.

    It is not known whether exercise benefits white matter connectivity in patients with schizophrenia.

    “However, it is not known if exercise benefits white matter connectivity in patients with schizophrenia.”

  • The paper relies on this without support.

    When a skill is endemic in a population, learning is not involved.

    “When the skill is endemic in a population, it is evident that learning is not involved.”

  • The paper relies on this without support.

    Biking is an overlearned physical skill.

    “practicing an overlearned physical skill (ie, biking)”

  • The paper relies on this without support.

    FA is a valid measure of white matter integrity/brain connectivity.

    “improves brain connectivity”
    “increasing white matter integrity”
4 of 4

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • LILF is defined as two different tracts

    Minor

    The methods define LILF as the left inferior longitudinal fascicle, but the Table 2 note defines it as the left inferior fronto-occipital fascicle, which the same note also calls LIFOF.

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Cites

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Research works printed but not linked: 1

  1. American Psychiatric Association, 2000, Diagnostical and Statistical Manual of Mental Disorders

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Authors
Svatkova, A., Mandl, R. C. W., Scheewe, T. W., Cahn, W., Kahn, R. S., & Hulshoff Pol, H. E.
Affiliations
University Medical Center Utrecht (NL)
ORCID
Venue
Schizophrenia Bulletin
Publisher
Oxford University Press (OUP)
Published
2015-03-31
Volume
41
Issue
4
Pages
869-878
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
DOI
10.1093/schbul/sbv033
PMC
PMC4466190
OpenAlex
W2133556985
Semantic Scholar
95b6b395f1b96b2eca5911b379e5ac4feca243e7
Cited by
120
References
84
Citations by year
2026: 3 · 2025: 9 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 15 · 2020: 15 · 2019: 15 · 2018: 9 · 2017: 12 · 2016: 10 · 2015: 5
FWCI
9.73
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
physical activity, cycling
MeSH terms
Adult, Bicycling, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Schizophrenia, Treatment Outcome, Young Adult, Diffusion Tensor Imaging, White Matter

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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