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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]
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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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“In addition to addiction, the benefits of physical training in psychological disorders ranging from depression to schizophrenia have been reported in patients undergoing an exercise regimen (Dauwan et al., 2016; McEwen et al., 2015).”
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“Several recent systematic reviews and meta-analyses have demonstrated that yoga is effective in ameliorating symptoms of depression across a range of different clinical disorders, includingMDD [45–48], posttraumatic stress disorder (PTSD) [49], stress and anxiety [50], and schizophrenia [51], as well as at-risk sample…”
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“Research examining the health impact of exercise interventions for individuals with SSDs is promising (Dauwan et al., 2016; Firth et al., 2015; Rosenbaum et al., 2014).”
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“stress relief, and exercise regime can have a profound effect on the frequency and severity of symptoms and reduce the likelihood of developing comorbidities that add to the disease burden [7, 12, 13].”
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“ment, Dauwan et al. (2015) examined the effect of structured and unstructured types of exercise intervention on outcomes of symptom severity (e.g. PANSS scores), cognition and quality of life. Dauwan et al. (2015) identified studies investigating yoga – forms of physical activity explicitly omitted from this present s…”
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“Numerous studies demonstrate the considerable protective effects of exercise on human diseases such as neurological disorders[9, 10], cardiovascular diseases[11, 12], as well as metabolic, inflammatory, and oncological conditions[13].”
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 16
“…evidence appears promising, demonstrating that exercise treatments improve both cognitive functioning (Dauwan et al., 2016; Fernández-Abascal et al., 2021; Korman et al., 2023) and daily life functioning (Dauwan et al., 2016; Fernández-Abascal et al., 2021; Korman et al., 2023) in schizophrenia.”
InfluentialChapman, J., Korman, N., Malacova, E., Robertson, C. V., Arnautovska, U., Siskind, D. J., Suetani, S., Stubbs, B., & Vancampfort, D. (2024) · Psychological Medicine · doi:10.1017/s0033291724001879 · Cited by 13
“…(Stubbs et al., 2016; Vancampfort et al., 2016c), and efficacy in reducing metabolic risk factors and improving symptoms of mental illnesses (Dauwan, Begemann, Heringa, & Sommer, 2015; Schuch et al., 2016); however, little is known about how to facilitate long-term healthy lifestyle…”
Motor impairments in early onset schizophrenia
Byrial, P., Nyboe, L., Thomsen, P. H., & Clausen, L. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13185 · Cited by 13
Association between aerobic fitness and the functional connectome in patients with schizophrenia
Roell, L., Maurus, I., Keeser, D., Karali, T., Papazov, B., Hasan, A., Schmitt, A., Papazova, I., Lembeck, M., Hirjak, D., et al. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01411-x · Cited by 13
“In people with schizophrenia, different kinds of exercise treatments show small to medium beneficial effects on positive [22–26] and negative symptom severity [22–25, 27, 28], depressive symptoms [24, 29], several cognitive domains [25, 26, 29, 30], quality of life [24, 29] and global functioning [24, 26, 31].”
BackgroundKurebayashi, Y., & Otaki, J. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.06.001 · Cited by 13
Ang, M. S., Nurjono, M., & Lee, J. (2019) · Quality of Life Research · doi:10.1007/s11136-019-02126-8 · Cited by 15
Resistance training in patients with schizophrenia: Concept and proof of principle trial
Maurus, I., Mantel, C., Keller-Varady, K., Schmitt, A., Lembeck, M., Röh, A., Papazova, I., Falkai, P., Schneider-Axmann, T., Hasan, A., et al. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.09.015 · Cited by 13
Panigrahi, A., Rao, G. N., & Konar, A. K. (2021) · Journal of Visual Impairment & Blindness · doi:10.1177/0145482x211028938 · Cited by 13
Lisoni, J., Nibbio, G., Baldacci, G., Zucchetti, A., Cicale, A., Zardini, D., Miotto, P., Deste, G., Barlati, S., & Vita, A. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.050 · Cited by 12
İnce, S. Ç., & Günüşen, N. P. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12745 · Cited by 12
Mayeli, 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
Kurebayashi, Y., & Otaki, J. (2017) · BMC Psychiatry · doi:10.1186/s12888-016-1176-z · Cited by 11
“However, most previous studies have only investigated the correlation between physical activity and memory or general cognitive function [13].”
BackgroundExercise and Antipsychotic Drugs
Mary, V. S. (2017) · Journal of Patient Care · doi:10.4172/2573-4598.1000114 · Cited by 11
“Exercise is one factor that has been shown to temporarily enhance treatment effects in schizophrenia [2-8].”
BackgroundThe Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia
Herbsleb, M., Keller-Varady, K., Wobrock, T., Hasan, A., Schmitt, A., Falkai, P., Gabriel, H. H. W., Bär, K., & Malchow, B. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00090 · Cited by 14
“Additionally to somatic health benefits, aerobic exercise positively impacts core features of the disease itself like cognitive deficits (15–17) and negative symptoms (18).”
BackgroundFocus on Brain Health to Improve Care, Treatment, and Rehabilitation in Forensic Psychiatry
Andiné, P., & Bergman, H. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00840 · Cited by 11
“In patients with schizophrenia, aerobic exercise has positive effects on psychotic symptoms, cognitive function, general functional outcomes and quality of life (43, 44).”
BackgroundSørensen, M., Bentzen, M., & Farholm, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00087 · Cited by 25
Tréhout, M., & Dollfus, S. (2018) · L Encéphale · doi:10.1016/j.encep.2018.05.005 · Cited by 17
The impact of endurance training and table soccer on brain metabolites in schizophrenia
Rauchmann, B., Ghaseminejad, F., Keeser, D., Keller-Varady, K., Schneider-Axmann, T., Takahashi, S., Karali, T., Helms, G., Dechent, P., Maurus, I., et al. (2019) · Brain Imaging and Behavior · doi:10.1007/s11682-019-00198-1 · Cited by 11
Functioning in schizophrenia: a Delphi study covering the perspective of physiotherapists
Nuño, L., Barrios, M., Vancampfort, D., Rojo, E., Gómez‐Benito, J., & Guilera, G. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1748729 · Cited by 11
Damiani, S., Stefanelli, R., Fortea, L., D'Imperio, A., Calò, M., Casarini, F., Crippa, A., Esposito, C. M., Leggi, R., Marika, O., et al. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03543-1 · Cited by 12
“Lastly, lifestyle interventions such as aerobic or mind-body exercise also demonstrated moderate ef fi cacy across trials [29 – 31].”
Lisoni, J., Nibbio, G., Baglioni, A., Dini, S., Manera, B., Maccari, A., Altieri, L., Calzavara‐Pinton, I., Zucchetti, A., Deste, G., et al. (2024) · Brain Sciences · doi:10.3390/brainsci14111067 · Cited by 11
The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey
Bergman, H., Nilsson, T., Andiné, P., Degl’Innocenti, A., Thomeé, R., & Gutke, A. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1875406 · Cited by 10
“The use of exercise to treat psychiatric symptoms and cognitive deficits in severe mental illness is still a relatively novel concept, but the evidence base has grown stronger in recent years (Dauwan et al., 2016; Firth et al., 2017; Stubbs et al., 2018).”
BackgroundInfluentialOccupational Outcomes of a Physical Activity Intervention for Post-Secondary Student Mental Health
Nesbitt, A. E., Collins, K. J., Nalder, E. J., & Sabiston, C. M. (2021) · Canadian Journal of Occupational Therapy · doi:10.1177/00084174211021708 · Cited by 12
Vila-Barrios, L., Carballeira, E., Varela-Sanz, A., Iglesias‐Soler, E., & Dopico-Calvo, X. (2023) · Behavioral Sciences · doi:10.3390/bs13120959 · Cited by 10
“However, there is controversy about which exercise modalities have positive effects on QoL, cognition, and psychopathological symptoms [34,35].”
BackgroundNasstasia, Y., Baker, A., Halpin, S. A., Lewin, T. J., Hides, L. M., Kelly, B. J., & Callister, R. (2016) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000611 · Cited by 10
“Recent meta-analyses have highlighted potential benefits of physical exercise for mental health conditions (Dauwan et al., 2016; Schuch et al., 2016).”
BackgroundCould physical exercise be an effective treatment for adults with borderline personality disorder?
St‐Amour, S., Cailhol, L., Ruocco, A. C., & Bernard, P. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113625 · Cited by 10
Midtgaard, J., Schnor, H., Bjerre, E. D., Jespersen, T., Jelsøe, N., Frølund, N., Seier, S., Rønbøg, J. W., Nordsborg, N. B., & Ebdrup, B. H. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-021-00900-5 · Cited by 11
Cai, H., Du, R., Zhang, J., Wang, X. Y., Li, W., Yang, K., & Wang, Z. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1478625 · Cited by 9
Integrative Medicine and Mood, Emotions and Mental Health
Shah, A. K., Becicka, R., Talen, M. R., Edberg, D., & Namboodiri, S. (2017) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2017.02.003 · Cited by 9
Nonpharmacological treatment of dyscognition in schizophrenia: effects of aerobic exercise
Maurus, I., Röh, A., Falkai, P., Malchow, B., Schmitt, A., & Hasan, A. (2019) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2019.21.3/aschmitt · Cited by 9
Gaalema, D. E., Mahoney, K., & Ballon, J. S. (2021) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000644 · Cited by 10
Nagata, S., McCormick, B. P., & Austin, D. R. (2020) · Therapeutic Recreation Journal · doi:10.18666/trj-2020-v54-i1-9745 · Cited by 12
Yoga 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
Sanchis-Asensi, A., Triviño-Juárez, J. M., Sanchis-Almiñana, H., & Ayuso, D. M. R. (2022) · Occupational Therapy in Mental Health · doi:10.1080/0164212x.2022.2125925 · Cited by 8
Romain, A. J., Cadet, R., & Baillot, A. (2020) · Science of Nursing and Health Practices · doi:10.31770/2561-7516.1084 · Cited by 8
“Indeed, several studies showed its beneficial effects on several outcomes including weight management, cardiovascular health, functioning, or psychotic symptoms (Dauwan et al., 2016; Firth et al., 2017; Ohi et al., 2018; Romain et al., 2019; Rosenbaum et al., 2015).”
BackgroundResultRampino, 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
Akbaş, E., Erdem, E. U., Guneş, E., Özkan, T. D., & Kınıklı, G. İ. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1929613 · Cited by 8
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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