Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis
Open accessAbstract
Cognitive deficits are pervasive among people with schizophrenia and treatment options are limited. There has been an increased interest in the neurocognitive benefits of exercise, but a comprehensive evaluation of studies to date is lacking. We therefore conducted a meta-analysis of all controlled trials investigating the cognitive outcomes of exercise interventions in schizophrenia. Studies were identified from a systematic search across major electronic databases from inception to April 2016. Meta-analyses were used to calculate pooled effect sizes (Hedges g) and 95% CIs. We identified 10 eligible trials with cognitive outcome data for 385 patients with schizophrenia. Exercise significantly improved global cognition (g = 0.33, 95% CI = 0.13-0.53, P = .001) with no statistical heterogeneity (I2 = 0%). The effect size in the 7 studies which were randomized controlled trials was g = 0.43 (P < .001). Meta-regression analyses indicated that greater amounts of exercise are associated with larger improvements in global cognition (β = .005, P = .065). Interventions which were supervised by physical activity professionals were also more effective (g = 0.47, P < .001). Exercise significantly improved the cognitive domains of working memory (g = 0.39, P = .024, N = 7, n = 282), social cognition (g = 0.71, P = .002, N = 3, n = 81), and attention/vigilance (g = 0.66, P = .005, N = 3, n = 104). Effects on processing speed, verbal memory, visual memory and reasoning and problem solving were not significant. This meta-analysis provides evidence that exercise can improve cognitive functioning among people with schizophrenia, particularly from interventions using higher dosages of exercise. Given the challenges in improving cognition, and the wider health benefits of exercise, a greater focus on providing supervised exercise to people with schizophrenia is needed.
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Exercise may have important effects on psychiatric symptoms and neurocognitive functioning across many conditions, potentially acting as a transdiagnostic treatment for mental disorders.
“there is increasing recognition that exercise may have important effects on psychiatric symptoms [32][33][34] and neurocognitive functioning [32], across many conditions, thus potentially acting as a transdiagnostic treatment for mental disorders.”
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 [33]
The Discussion (page unavailable) reports cognitive benefits of exercise in people with schizophrenia and notes prior evidence of improved psychiatric symptoms in that population. The Methods’ Eligibility Criteria (page unavailable) limit this review to schizophrenia and related nonaffective psychosis; it does not establish effects across many conditions. The transdiagnostic-treatment proposal is the citing authors’ inference, not a finding of this review. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn people with schizophrenia spectrum disorder, aerobic exercise improved global cognition versus control conditions (g = 0.412, 95% CI 0.19-0.64, p < 0.001) in a meta-analysis of seven RCTs and 292 people.
“A meta-analysis of seven RCTs [33] (AMSTAR = 5, AMSTAR+ = 3) of aerobic exercise and 292 people with schizophrenia spectrum disorder found that exercise improved global cognition versus control conditions which included table football alone (N = 1), occupational therapy (N = 1) and TAU (N = 5) (g = 0.412, 95% CI 0.19-0.64,p < 0.001).”
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 [33]
The Results table and the ‘Meta-Analysis of the Neurocognitive Outcomes of Exercise’ section report that seven RCTs found improved global cognition versus controls (g = 0.412, 95% CI 0.19–0.64, P < .001). They report 297 participants, not 292. The ‘Included Studies and Participant Details’ section lists the cited control types, though it describes the included studies overall rather than assigning those counts specifically to the seven RCTs. (LLM, conf=0.92)
Experimental — accuracy not yet measuredThere is tentative evidence that moderate-to-vigorous intensity aerobic and resistance training exercise improves mental health symptoms and cognition in people with schizophrenia spectrum disorders.
“Second, there is tentative evidence that moderate-to-vigorous intensity aerobic and resistance training exercise improves mental health symptoms and cognition in people with schizophrenia spectrum disorders [33,34,70].”
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 [33]
The Results and Discussion support cognitive benefits from exercise in people with schizophrenia, and the Introduction reports evidence of improvements in psychiatric symptoms. But the included interventions were primarily aerobic; the Discussion says resistance-training evidence for cognition came from single-arm studies, and it does not establish moderate-to-vigorous intensity as the effective level. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe emerging data suggest that higher intensities of aerobic exercise may produce neuropsychiatric benefits in people with schizophrenia/serious mental illness.
“Nonetheless, the emerging data suggest that higher intensities of aerobic exercise may produce neuropsychiatric benefits in this population [33,34,80].”
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 [33]
The Discussion (page not provided) reports that exercise intensity was the best predictor of cognitive improvement in a schizophrenia study, which supports the tentative claim about higher intensity. The paper did not analyze intensity across its pooled trials, and this evidence does not establish broader neuropsychiatric benefits or extend to serious mental illness generally. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn schizophrenia, exercise improves global cognition compared with control conditions.
“exercise improved global cognition in schizophrenia (meta-analyses = 1)”
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 [33]
For cognitive outcomes in schizophrenia/serious mental illness, greater effect sizes were observed by interventions which administered higher doses of exercise (minutes per week) and were delivered by a qualified exercise professional.
“For instance, for cognitive outcomes, greater effect sizes were observed by interventions which administered higher doses of exercise (minutes per week) and were delivered by a qualified exercise professional [33].”
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 [33]
In people with anxiety and stress disorders, exercise was effective versus non-active interventions in reducing anxiety symptoms.
“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 [33]
The Results (Meta-Analysis of the Neurocognitive Outcomes of Exercise; page unavailable) report improved cognition in people with schizophrenia, not reduced anxiety symptoms in people with anxiety or stress disorders. Searches for anxiety and stress disorders, anxiety symptoms, and non-active interventions found no passage in our copy addressing the attributed claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPhysical activity-based interventions have demonstrated efficacy in treating symptoms of several mental health conditions ranging from psychosis to dementia.
“Physical activity (PA)-based interventions represent a novel approach that have demonstrated efficacy in treating symptoms of several mental health conditions ranging from psychosis (e.g. [28, 29]) to dementia (e.g. [30]).”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [29]
In mental health conditions, physical activity has wider benefits including improved quality of life, less psychological distress and improved physical health.
“In such mental health conditions, PA has been shown to have wider benefits to peoples’ wellbeing, including an improved quality of life, less psychological distress and, importantly, improved physical health [28, 29, 38–43].”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [29]
Physical activity in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing.
“PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing.”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [29]
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Sommer, I. E., & Kahn, R. S. (2015) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv031 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [62]Mahncke H Kim SJ Stasio C Results of an FDA device clearance trial for plasticity-based adaptive cognitive remediation (PACR). Npj Schizophrenia. 2016; 2: 16007.
Cited by
Sorted by citations
Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines
ERICKSON, K. I., HILLMAN, C., STILLMAN, C. M., BALLARD, R. M., BLOODGOOD, B., CONROY, D. E., MACKO, R., MARQUEZ, D. X., PETRUZZELLO, S. J., & POWELL, K. E. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001936 · Cited by 1,214 · see citing works
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., Probst, M., Ward, P. B., Gaughran, F., De Hert, M., et al. (2017) · World Psychiatry · doi:10.1002/wps.20458 · Cited by 957 · see citing works
Self-citationStubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., Brand, S., Cordes, J., Malchow, B., Gerber, M., et al. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2018.07.004 · Cited by 697 · see citing works
Self-citationNonsocial and social cognition in schizophrenia: current evidence and future directions
Green, M. F., Horan, W. P., & Lee, J. (2019) · World Psychiatry · doi:10.1002/wps.20624 · Cited by 612 · see citing works
Effect of aerobic exercise on hippocampal volume in humans: A systematic review and meta-analysis
Firth, J., Stubbs, B., Vancampfort, D., Schuch, F., Lagopoulos, J., Rosenbaum, S., & Ward, P. B. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2017.11.007 · Cited by 526 · see citing works
Self-citationDaskalopoulou, C., Stubbs, B., Kralj, C., Koukounari, A., Prince, M., & Prina, A. M. (2017) · Ageing Research Reviews · doi:10.1016/j.arr.2017.06.003 · Cited by 501 · see citing works
“Based on recent systematic reviews, exercise has been characterised as an evidence-based treatment for depression (Schuch et al., 2016) and as a resource of improvement of cognition, working memory and attention to detail for patients with schizophrenia (Firth et al., 2016).”
Self-citationAshdown-Franks, G., Firth, J., Carney, R., Carvalho, A. F., Hallgren, M., Koyanagi, A., Rosenbaum, S., Schuch, F. B., Smith, L., Solmi, M., et al. (2020) · Sports Medicine · doi:10.1007/s40279-019-01187-6 · Cited by 446 · see citing works
Self-citationMoving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety
Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0923-x · Cited by 291 · see citing works
Self-citationMaj, M., van Os, J., De Hert, M., Gaebel, W., Galderisi, S., Green, M. F., Guloksuz, S., Harvey, P. D., Jones, P. B., Malaspina, D., et al. (2021) · World Psychiatry · doi:10.1002/wps.20809 · Cited by 285 · see citing works
Self-citationExercise Intervention in PTSD: A Narrative Review and Rationale for Implementation
Hegberg, N. J., Hayes, J. P., & Hayes, S. M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00133 · Cited by 154 · see citing works
Firth, J., Stubbs, B., Vancampfort, D., Firth, J. A., Large, M., Rosenbaum, S., Hallgren, M., Ward, P. B., Sarris, J., & Yung, A. R. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby034 · Cited by 105 · see citing works
Self-citationFirth, J., Firth, J. A., Stubbs, B., Vancampfort, D., Schuch, F. B., Hallgren, M., Veronese, N., Yung, A. R., & Sarris, J. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0503 · Cited by 94 · see citing works
Self-citationA systematic review of cognitive effects of exercise in depression
Brondino, N., Rocchetti, M., Fusar‐Poli, L., Codrons, E., Correale, L., Vandoni, M., Barbui, C., & Politi, P. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12690 · Cited by 94 · see citing works
Marx, W., Scholey, A., Firth, J., D’Cunha, N. M., Lane, M., Hockey, M., Ashton, M. M., Cryan, J. F., O’Neil, A., Naumovski, N., et al. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.07.036 · Cited by 87 · see citing works
Self-citationThe pro‐cognitive mechanisms of physical exercise in people with schizophrenia
Firth, J., Cotter, J., Carney, R., & Yung, A. R. (2017) · British Journal of Pharmacology · doi:10.1111/bph.13772 · Cited by 79 · see citing works
Self-citationDeenik, J., Czosnek, L., Teasdale, S. B., Stubbs, B., Firth, J., Schuch, F. B., Tenback, D. E., van Harten, P. N., Tak, E. C. P. M., Lederman, O., et al. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz067 · Cited by 77 · see citing works
Self-citationBrokmeier, L. L., Firth, J., Vancampfort, D., Smith, L., Deenik, J., Rosenbaum, S., Stubbs, B., & Schuch, F. B. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2019.112675 · Cited by 56 · see citing works
Self-citationLi, J., Shen, J., Wu, G., Tan, Y., Sun, Y., Keller, E., Jiang, Y., & Wu, J. (2018) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2018.04.003 · Cited by 44 · see citing works
Sun, H., Gao, X., Que, X., Liu, L., Ma, J., He, S., Gao, Q., & Wang, T. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.034 · Cited by 33 · see citing works
Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia
Kimhy, D., Tay, C., Vakhrusheva, J., Beck-Felts, K., Ospina, L. H., Ifrah, C., Parvaz, M., Gross, J. J., & Bartels, M. N. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-020-01220-0 · Cited by 27 · see citing works
Tacchi, M. J., Heggelund, J., & Scott, J. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12783 · Cited by 24 · see citing works
Giusti, L., Bianchini, V., Aggio, A., Mammarella, S., Salza, A., Necozione, S., Alunno, A., Ferri, C., Casacchia, M., & Roncone, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.903759 · Cited by 6 · see citing works
- Authors
- Firth, J., Stubbs, B., Rosenbaum, S., Vancampfort, D., Malchow, B., Schuch, F., Elliott, R., Nuechterlein, K. H., & Yung, A. R.
- Affiliations
- University of Manchester (GB)
- King's College London (GB)
- UNSW Sydney (AU)
- KU Leuven (BE)
- Ludwig-Maximilians-Universität München (DE)
- Hospital de Clínicas de Porto Alegre (BR)
- University of California, Los Angeles (US)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- Corresponding author
- Firth, Joseph
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-08-11
- Volume
- 43
- Issue
- 3
- Pages
- sbw115
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC5464163
- OpenAlex
- W2507368141
- Cited by
- 488
- References
- 70
- Citations by year
- 2026: 17 · 2025: 42 · 2024: 71 · 2023: 49 · 2022: 45 · 2021: 50 · 2020: 52 · 2019: 64 · 2018: 52 · 2017: 39 · 2016: 6 · 2013: 1
- FWCI
- 7.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Schizophrenia Bulletin (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Lirias (KU Leuven) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Stanley Medical Research Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- aerobic exercise, schizophrenia
- MeSH terms
- Humans, Schizophrenia, Exercise, Cognitive Dysfunction
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.
Statistics and arithmetic are recomputed, not judged.
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