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Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial

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Dubreucq, Julien, Gabayet, Franck, Ycart, Bernard, Faraldo, Megane, Melis, Fanny, Lucas, Thierry, Arnaud, Benjamin, Bacconnier, Mickael +17 more·2020·European Psychiatry
DOI 10.1192/j.eurpsy.2020.42PMC PMC7355162
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Abstract

Background.: Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed. Methods.: we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment. Results.: Eighty-seven people with schizophrenia were included and allocated to either the RR group (n= 57) or the TR group (n= 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP],p< 0.001,d= 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative,p< 0.001,d= 0.827; PANSS GP,p< 0.001,d= 0.991; PANSS positive,p= 0.009,d= 0.594), verbal abstraction (p= 0.008,d= 0.554), aggression bias (p= 0.008,d= 0.627), and self-stigma (stereotype endorsement,p= 0.019,d= 0.495; discrimination experiences,p= 0.047;d= 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up. Conclusions.: Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.

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  • Physical exercise interventions improved social functioning in psychosis compared to treatment-as-usual.

    “Four studies found statistically significant improvements in social functioning in psychosis compared to the treatment‐as‐usual (TAU) group (Dubreucq et al. 2020; Firth et al. 2018; Kimhy et al. 2021; Şenormancı et al. 2021).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Dubreucq et al. 2020

    The Results section, “Changes in social functioning” (page unavailable), reports a statistically significant improvement in social functioning for the RemedRugby group. But the comparison group played rugby under professional supervision, not treatment as usual; the intervention also combined exercise with social-cognitive remediation. The cited study therefore supports the improvement, but not the claimed comparator or an exercise-only interpretation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The one FEP physical exercise study (mean age 25.85) was characterised by more vigorous and intense exercise regimes, whereas the two schizophrenia studies (mean age 33-43) engaged in low-intensity exercises.

    “For example, the one FEP study (mean age = 25.85) was characterised by more vigorous and intense exercise regimes (Firth et al. 2018), whereas the two schizophrenia studies (mean age = 33–43) engaged in low‐intensity exercises such as brisk walking or resistance band exercises (Dubreucq et al. 2020; Şenormancı et al. 2021).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Dubreucq et al. 2020

    Materials and Methods (Trial design and participants; page unavailable) reports mean ages of 33.3 and 33.1 for the two schizophrenia-study groups. The Introduction and Interventions sections describe Touch Rugby adapted to participants’ fitness, but do not classify it as low-intensity exercise or describe brisk walking or resistance-band exercises. This source therefore supports the age range, not the attributed exercise characterization. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The negative findings for physical exercise may be attributed to the sample having a higher mean age (55) compared to younger cohorts (age range 25-40) who appeared to benefit more.

    “The negative findings might also be attributed to the sample having a higher mean age (55) (Kern et al. 2020), compared to the younger cohorts (age range 25–40) who appeared to benefit more from this type of intervention (Dubreucq et al. 2020; Firth et al. 2018; Kimhy et al. 2021; Şenormancı et al. 2021).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Dubreucq et al. 2020

    The Trial design and participants section reports mean ages of 33.3 and 33.1 years, and Results > Changes in social functioning reports greater improvement with RemedRugby than with rugby alone. This supports an example of a younger cohort benefiting from an exercise-enriched intervention, but not the suggestion that younger patients benefit more because of their age: the beneficial intervention also included social-cognitive remediation, and the paper does not compare outcomes across age cohorts. The cited mean age of 55 is attributed to Kern et al., not to this source. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Physical exercise interventions that demonstrated significant social functioning outcomes ranged from 10 weeks to 3 months with 60-120 min of weekly sessions.

    “Interventions that demonstrated statistically significant social functioning outcomes ranged from 10 weeks to 3 months with 60–120 min of weekly sessions (Dubreucq et al. 2020; Firth et al. 2018; Kimhy et al. 2021; Şenormancı et al. 2021).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Dubreucq et al. 2020

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Authors
Dubreucq, J., Gabayet, F., Ycart, B., Faraldo, M., Melis, F., Lucas, T., Arnaud, B., Bacconnier, M., Bakri, M., Cambier, G., Carmona, F., Chereau, I., Challe, T., Morel, S., Pires, S., Roussel, C., Lamy, P., Legrand, G., Pages, E., Pommier, R., Rey, R., Souchet, Y., Llorca, P.-M., Massoubre, C., & the RemedRugby Group
Affiliations
  • Lyon 1 Université (FR)
  • Fondation FondaMental (FR)
  • Centre National de la Recherche Scientifique (FR)
  • Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
  • Centre Médical de La Teppe (FR)
  • Centre Hospitalier de Vitré (FR)
  • Centre Hospitalier Universitaire de Saint-Étienne (FR)
Corresponding author
Dubreucq, Julien
ORCID
Venue
European Psychiatry
Publisher
Royal College of Psychiatrists
Published
2020
Volume
63
Issue
1
Pages
e41-e41
ISSN
  • 0924-9338 (ISSN-L)
  • 1778-3585
DOI
10.1192/j.eurpsy.2020.42
PMC
PMC7355162
OpenAlex
W3021188829
Cited by
20
References
10
Citations by year
2026: 1 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 4
FWCI
1.82
Type
journal article
Language
en
Open access
Licence
Locations
  • European Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
schizophrenia, functional capacity, social functioning, physical activity, rugby, self-stigma, negative symptoms, cognitive impairment, real-world functioning
MeSH terms
Cognitive Remediation, Adult, Combined Modality Therapy, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Schizophrenia, Social Behavior, Social Skills

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