Abstract
BackgroundThe focus in recent years on physical inactivity and metabolic disturbances in individuals with schizophrenia raises the question of potential effects of physical activity. Physical activity has shown beneficial effects on cognition in healthy older individuals as well as on symptom severity in depression. However, opinions diverge regarding whether aerobic high-intensity interval training reduces cognition and key symptoms in schizophrenia. The main objective for the trial is to investigate the potential effects of aerobic high-intensity interval training on neurocognitive function and mental symptoms in outpatients with schizophrenia.Methods/DesignThe trial is designed as a randomized controlled, observer-blinded clinical trial. Patients are randomized to 1 of 2 treatment arms with 12-week duration: aerobic high-intensity interval training or computer gaming skills training. All participants also receive treatment as usual. Primary outcome measure is neurocognitive function. Secondary outcome measures will be positive and negative symptoms, wellbeing, tobacco-smoking patterns and physiological/metabolic parameters. Patient recruitment takes place in catchment area-based outpatient clinics.Trial registrationClinicalTrials.gov NCT02205684. Registered 29 July 2014.
Highlights
The focus in recent years on physical inactivity and metabolic disturbances in individuals with schizophrenia raises the question of potential effects of physical activity
Physical activity has been shown to reduce symptoms of depression and increase cognitive functions in other groups associated with cognitive dysfunction such as Parkinson’s disease [78, 79] and old age [80,81,82]
Wellvalidated measures of the respective functional domains serve as main outcome measures and assessments are performed pre-training, immediately after completed training and 4 months post-treatment allowing appraisal of possible delay between increased cardiorespiratory fitness (CRF) and reduced symptoms
Summary
Schizophrenia is a severe mental illness characterized by delusions and hallucinations (i.e. positive symptoms), affect flattening, poverty of speech, lack of motivation and social withdrawal (i.e. negative symptoms) and cognitive impairment, making it one of the leading causes of disability in the age group 15–44 years [1,2,3]. Significant improvements were found in short-term and long-term verbal memory and cognitive flexibility from the start of the combined intervention at week 6 to the end of the 3month training period in the group exposed to endurance training augmented with cognitive remediation. This, taken together with an unhealthy lifestyle, underscores the need for multidisciplinary treatment and underlines the need for addressing physical activity and, in particular, highintensity interval training, which is more effective than moderate intensity exercise in increasing CRF in the short term [37, 38]. We aim to conduct a trial where these methodological considerations are addressed by comparing a 12-week aerobic high-intensity interval training (HIIT) program to skills training of the same duration, with regard to: 1) aspects of cognitive function, especially memory, attention and executive function, and 2) psychiatric symptom load (negative and positive symptoms) and wellbeing. The effects of HIIT on maximum oxygen uptake and risk factors for CVD (i.e. tobacco- smoking, elevated blood pressure, dyslipidemia, insulin resistance and high body fat) are subject to investigation
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