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

The DOI matches its Crossref record; 84 of the 84 references it cites were found in a registry or an index; 1 of the 58 sources its claims cite were checked for support.

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

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.

Overview

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.

Verification

Claims the paper makes

25 Not checked yet · 23 Own result · 14 Own interpretation · 10 Own method · 1 Not supported · accuracy not yet measured

Verify all 57 references — free account
  • Probably not a substantial claim. 31
  • It may state two separate claims as one. 22
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

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Self-check

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1 of 1

Citations

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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Metadata

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)
Venue
Schizophrenia Bulletin
Published
2015-03-31
Volume
41
Issue
4
Pages
869-878
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
OpenAlex
W2133556985
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 › Public Health, Environmental and Occupational Health › 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

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