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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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Rajaie, S. H., Soltani, S., Yazdanpanah, Z., Zohrabi, T., Beigrezaei, S., Mohseni‐Takalloo, S., Kaviani, M., Forbes, S. C., Baker, J. S., & Salehi‐Abargouei, A. (2022) · Quality of Life Research · doi:10.1007/s11136-022-03146-7 · Cited by 3
“Systematic reviews and meta-analyses assessing the effects of exercise during weight-loss interventions on the HRQOL [16, 17] and depression [18, 19] have shown beneficial effects.”
BackgroundGorain, R. K., Ramu, R., Sinha, P., & Govindan, R. (2022) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_904_21 · Cited by 3
“[29] Moreover, a meta‐analysis study found that short‐or long‐term physical training enhanced both positive and negative symptoms.[25] Thus, our finding supports the notion that structured physical activity may have a clinical prognostic impact on severe mental illness patients and adopting a well‐structured physical…”
BackgroundPerspectivas sobre a atuação da Fisioterapia na Saúde Mental
Goulardins, J. B., Canales, J. Z., & Oda, C. (2019) · Revista Pesquisa em Fisioterapia · doi:10.17267/2238-2704rpf.v9i2.2311 · Cited by 3
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Roell, L., & Maurus, I. (2023) · doi:10.31219/osf.io/y2phs · Cited by 3
Yilmaz, D., Papiol, S., Keeser, D., Cole, J. H., Malchow, B., Schmitt, A., Falkai, P., Maurus, I., & Roell, L. (2025) · medRxiv · doi:10.1101/2025.01.08.24319554 · Cited by 3
Chan, Y. E., Lin, W., Lai, H. ‐., Hung, C., & Huang, M. (2024) · Asia-Pacific Psychiatry · doi:10.1111/appy.12556 · Cited by 2
“Most research to date has focused on the effectiveness of incorporating aerobic exercise alongside existing treatments to enhance overall psychopathological symptoms and cognitive function among patients with schizophrenia (Dauwan et al., 2016).”
BackgroundTous‐Espelosin, M., Pavón, C., Elizagárate, E., Sampedro, A., & Maldonado‐Martín, S. (2024) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14707 · Cited by 2
Bitter, I., Czobor, P., & Tombor, L. (2025) · Brain Sciences · doi:10.3390/brainsci15050499 · Cited by 2
Subotnik, K. L., Ventura, J., McEwen, S. C., Turner, L. R., Sturdevant, Y. R., Distler, M. G., Casaus, L. R., Zito, M. F., Hellemann, G., Sugar, C. A., et al. (2025) · Behavior Modification · doi:10.1177/01454455251371021 · Cited by 2
“In their systematic review, Dauwan et al. (2016) concluded that there was evidence that aerobic exercise interventions in schizophrenia reduce positive symptoms, but the effect sizes varied across studies and many were nonsignificant (Heggelund et al., 2011).”
O’Donoghue, J., Fahy, Y. P., Tummon, A., McDonald, C., & Hallahan, B. P. (2025) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2025.10117 · Cited by 2
“In addition to its well documented cardio-metabolic benefits, exercise has been shown to reduce clinical symptoms of schizophrenia (Dauwan et al. 2016).”
Beyond Kraepelin: An Aetiological Approach to the Typology and Treatment of Psychosis
Murray, R. M., Alameda, L., Dima, A., & Oliver, D. (2026) · Springer eBooks · doi:10.1007/978-3-032-09475-9_25 · Cited by 2
Rehder, J., Timm, I., Berretz, G., Reinhard, I., Neubauer, A. B., Güntürkün, O., Takano, K., Bierbauer, W., Cabrita, M., Bourke, M., et al. (2026) · Nature Human Behaviour · doi:10.1038/s41562-026-02427-2 · Cited by 4
“To statistically test for temporal directionality, we conducted a two-stage IPD meta-analysis considering both temporal directions in one model (Supplementary Information Section 10).”
Alqudah, M., Khalifeh, M., Al-Azaizeh, R., Masaadeh, A. H., Al-Rusan, O. M., & Haddad, H. K. (2022) · Pathology & Oncology Research · doi:10.3389/pore.2022.1610752 · Cited by 2
Venet-Kelma, L., Morvan, Y., Romain, A. J., Mendy, M., Meslier, M., Thoisy, I., Mulin, E., Chirio-Espitalier, M., Dadi, G., Moualla, M., et al. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01689-5 · Cited by 2
“In fact, they can be responsible for excessive fatigue, which exacerbates the lack of motivation with regard to lifestyle habits, including impoverishment in terms of physical activity (PA) [11].”
Chang, K.-T., Goh, K. K., Latthirun, K., & Yang, C.-T. (2024) · Progress in brain research · doi:10.1016/bs.pbr.2024.01.002 · Cited by 2
Gökcen, A., Ekici, G., Bağcı, E., & Şen, D. T. (2024) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2021.0037 · Cited by 2
Niv, N., Issa, F., Goldberg, R., Khandekar, P., McGraw, K., Reston, J. T., Ford, S. C., Katz, I. R., & Resnick, S. G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf035 · Cited by 2
“91 Dauwan and colleagues 88 observed variations in the effects of group and individual aerobic exercise, noting more robust effects for those participating in supervised programs, with better adherence in supervised and structured programs.”
Kern, L., Morvan, Y., Willard, D., & Amado, I. (2018) · Science & Sports · doi:10.1016/j.scispo.2018.03.030 · Cited by 2
Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily nursing
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Broderick, J. M., Vancampfort, D., Mockler, D., Bennett, K., Waugh, A., McDonough, C., Cramer, H., & Walshe, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013213 · Cited by 2
Sertel, M., Bezgin, S., Kurtoğlu, F., & ŞAHİN, H. H. K. (2022) · Journal of Exercise Therapy and Rehabilitation · doi:10.15437/jetr.705155 · Cited by 2
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Srisurapanont, M., Kunchanaphongphan, T., Chokemaitree, N., Prachason, T., Kanchanatawan, B., Suttajit, S., Sanguanvichaikul, T., Trisukon, W., Dendumrongkul, P., Chinvararak, C., et al. (2022) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2022.103044 · Cited by 2
Bipolar and Psychotic Disorders
Currie, A., & McAllister-Williams, H. (2022) · Springer eBooks · doi:10.1007/978-3-031-08364-8_12 · Cited by 1
Depression and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator in Women
Iordani, M. M., Polikandrioti, M., Kapadohos, T., Maggita, A., Kourea, K., Koutelekos, I., Dousis, E., & Zartaloudi, A. (2023) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-31986-0_12 · Cited by 1
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“Recent research confirmed comparable results and the positive effect of PA in inpatient settings [25–28], thereby also critically addressing the specific context of PAs for mentally ill inpatients based on e.g. physical health disparities or socioecological complexities [29, 30].”
Result“Don't ask me to be joyful!” – a qualitative study of the weight-neutral principle ‘joyful movement’
Petersen, M. L., Meyer, L. B., Sigurdardottir, G. A., Køster‐Rasmussen, R., Amlund, D., Bergmann, L. A., Steinbo, E. K. F., Specht, I. O., Waldorff, F. B., & Sandholdt, C. T. (2025) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2025.100658 · Cited by 1
Rißmayer, M., Fischer, J., Hanßen, R., Kretschmer, A. C., Blaschke, S. J., Jelic, S., Annas, S., Rihm, A., Markser, A. M., Krombholz, S., et al. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.03.017 · Cited by 1
Ventura, J., Roell, L., Maurus, I., & Firth, J. (2026) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgag006 · Cited by 1
Behavioural Interventions for Weight Management Among Patients with Schizophrenia
Duncan, M., Davison, K., Remington, G., & Faulkner, G. (2017) · Springer eBooks · doi:10.1007/978-3-319-42536-8_19 · Cited by 1
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
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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