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Exercise Improves Clinical Symptoms, Quality of Life, Global Functioning, and Depression in Schizophrenia: A Systematic Review and Meta-analysis
Open accessAbstract
BACKGROUND: Physical exercise may be valuable for patients with schizophrenia spectrum disorders as it may have beneficial effect on clinical symptoms, quality of life and cognition. METHODS: A systematic search was performed using PubMed (Medline), Embase, PsychInfo, and Cochrane Database of Systematic Reviews. Controlled and uncontrolled studies investigating the effect of any type of physical exercise interventions in schizophrenia spectrum disorders were included. Outcome measures were clinical symptoms, quality of life, global functioning, depression or cognition. Meta-analyses were performed using Comprehensive Meta-Analysis software. A random effects model was used to compute overall weighted effect sizes in Hedges' g. RESULTS: Twenty-nine studies were included, examining 1109 patients. Exercise was superior to control conditions in improving total symptom severity (k = 14, n = 719: Hedges' g = .39, P < .001), positive (k = 15, n = 715: Hedges' g = .32, P < .01), negative (k = 18, n = 854: Hedges' g = .49, P < .001), and general (k = 10, n = 475: Hedges' g = .27, P < .05) symptoms, quality of life (k = 11, n = 770: Hedges' g = .55, P < .001), global functioning (k = 5, n = 342: Hedges' g = .32, P < .01), and depressive symptoms (k = 7, n = 337: Hedges' g = .71, P < .001). Yoga, specifically, improved the cognitive subdomain long-term memory (k = 2, n = 184: Hedges' g = .32, P < .05), while exercise in general or in any other form had no effect on cognition. CONCLUSION: Physical exercise is a robust add-on treatment for improving clinical symptoms, quality of life, global functioning, and depressive symptoms in patients with schizophrenia. The effect on cognition is not demonstrated, but may be present for yoga.
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“Data from one MA [69] of 5 RCTs found that aerobic exercise does not improve depressive symptoms”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“In those with anxiety and stress disorders, there was evidence that exercise was effective versus non-active interventions in reducing anxiety symptoms [33,34,69].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
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“It does appear from the paucity of RCTs available that aerobic exercise does improve depressive symptoms in schizophrenia [69].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
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“as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (metaanalyses = 2)”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
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“as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (metaanalyses = 2)”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
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“Whilst the data are encouraging for core psychiatric symptoms [34,69], this finding requires replication in large, controlled trials.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [69]
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“These results align with a meta-analysis indicating exercise and yoga to alleviate depressive symptoms in persons with schizophrenia.62”
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“Additionally, physical activity and its structured subset, exercise, results in improved mental health symptoms (Dauwan et al., 2016; Firth et al., 2015) as well as cognitive (Firth et al., 2016) and psychosocial functioning (Firth et al., 2015; Vancampfort et al., 2015).”
Backgroundvan der Stouwe, E. C. D., van Busschbach, J. T., de Vries, B., Cahn, W., Aleman, A., & Pijnenborg, G. H. M. (2018) · NeuroImage Clinical · doi:10.1016/j.nicl.2018.04.018 · Cited by 43
“Earlier systematic reviews indicated that moderate to vigorous exercise reduces both positive and negative symptoms in schizophrenia (Dauwan et al., 2016; Firth et al., 2015).”
BackgroundDamme, K. S. F., Gupta, T., Ristanovic, I., Kimhy, D., Bryan, A. D., & Mittal, V. A. (2022) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac084 · Cited by 40
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“, 2016 [31] Meta-analysis 17 (659) In one study, exercise improved verbal STM by 34% (p < 0.”
Kim, M., Lee, Y., & Kang, H. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043719 · Cited by 36
Ball, H., Yung, A. R., & Bucci, S. (2022) · Mental health and physical activity · doi:10.1016/j.mhpa.2022.100452 · Cited by 35
A Supervised Exercise Intervention for Youth at Risk for Psychosis
Dean, D. J., Bryan, A. D., Newberry, R. E., Gupta, T., Carol, E. E., & Mittal, V. A. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.16m11365 · Cited by 34
Vita, A., Nibbio, G., & Barlati, S. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116126 · Cited by 36
“…represent another category of treatment that has shown some direct efficacy in improving cognitive performance in people living with schizophrenia (Dauwan et al., 2016; Firth et al., 2017; Saviola et al., 2023; Stubbs et al., 2018), and they can be easily integrated with other effective…”
Lotfi, Y., Rezazadeh, N., Moossavi, A., Haghgoo, H. A., Rostami, R., Bakhshi, E., Badfar, F., Moghadam, S. F., Sadeghi‐Firoozabadi, V., & Khodabandelou, Y. (2017) · Auris Nasus Larynx · doi:10.1016/j.anl.2017.01.011 · Cited by 35
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Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine
Falkai, P., Schmitt, A., Rosenbeiger, C. P., Maurus, I., Hattenkofer, L., Hasan, A., Malchow, B., Heim-Ohmayer, P., Halle, M., & Heitkamp, M. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01360-x · Cited by 40
“For example, a well-cited meta-analysis showed that in patients with SZ aerobic exercise improves negative, positive, and depressive symptoms and global functioning, as measured by the Global Assessment of Functioning (GAF) score [53].”
MethodInterventions for improving psychosocial well-being after stroke: A systematic review
van Nimwegen, D., Hjelle, E. G., Bragstad, L. K., Kirkevold, M., Sveen, U., Hafsteinsdøttir, T. B., Schoonhoven, L., Visser‐Meily, J. M. A., & Ginkel, J. M. D. M. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104492 · Cited by 45
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Effectiveness of Cerebellar Circuitry Modulation in Schizophrenia: A Systematic Review
Escelsior, A., Belvederi Murri, M., Calcagno, P., Cervetti, A., Caruso, R., Croce, E., Grassi, L., & Amore, M. (2019) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000001064 · Cited by 32
Yoga bei psychischen Störungen
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Papiol, S., Keeser, D., Hasan, A., Schneider-Axmann, T., Raabe, F. J., Degenhardt, F., Rossner, M. J., Bickeböller, H., Cantuti‐Castelvetri, L., Simons, M., et al. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0618-z · Cited by 32
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“Moreover, PA shows positive effects on psychological well-being and anxiety [38] and can improve mental and physical quality of life, reducing metabolic risk and overweight [39, 40].”
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“Meta-analytic evidence suggests that aerobic physical exercise can reduce severity of symptoms (negative, positive, and general), improve cognitive performances (in particular, processing speed), and lead to better functional outcomes in patients with schizophrenia (Dauwan et al., 2015).”
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Diet, exercise, and mental disorders − public health challenges of the future
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Enhancing Neuroplasticity to Augment Cognitive Remediation in Schizophrenia
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A systematic review of trials investigating strength training in schizophrenia spectrum disorders
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Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia
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Physical activity as prognostic factor for bipolar disorder: An 18-month prospective study
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Moving from risk to resilience in psychosis research
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Metadata
- Authors
- Dauwan, M., Begemann, M. J. H., Heringa, S. M., & Sommer, I. E.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Dauwan, Meenakshi
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-07
- Volume
- 42
- Issue
- 3
- Pages
- 588-599
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC4838091
- OpenAlex
- W2176833440
- Cited by
- 393
- References
- 151
- Citations by year
- 2026: 21 · 2025: 34 · 2024: 43 · 2023: 42 · 2022: 44 · 2021: 40 · 2020: 40 · 2019: 51 · 2018: 28 · 2017: 37 · 2016: 11 · 2015: 1
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Schizophrenia Bulletin (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- physical activity, schizophrenia
- MeSH terms
- Depression, Exercise Therapy, Humans, Quality of Life, Schizophrenia, Outcome Assessment, Health Care, Cognitive Dysfunction
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