Benefits of Physical Exercise in Schizophrenia

Difficulties in social integration pose a major mental health problem for Veterans with
schizophrenia. Reviews of the literature indicate that Veterans with schizophrenia have lower
marriage rates, fewer friendships, and higher rates of living alone than the general
population. Poor social integration is also associated with early mortality. To gain traction
on this problem, it will be necessary to find treatments that address key determinants of
social integration. Evidence indicates that impairments in cognition and affect are among the
key determinants of this area of functioning. Findings from the broader rehabilitation
literature support a novel conceptual approach to this problem, namely engagement in physical
exercise. Physical exercise is associated with improvements in attention, episodic memory,
working memory, speed of processing, and executive control. In addition, physical exercise is
associated with increases in positive affect and decreases in negative affect. Findings on
the effects of physical exercise on cognition and affect have been reported for normal aging,
mild cognitive impairment, neurodegenerative disorders, oncology, and depression, but is an
area of investigation relatively new to schizophrenia. The proposed study will include 54
Veterans with schizophrenia or schizoaffective disorder (aged 45-65) who will be matched on
baseline levels of cardiorespiratory fitness, and then randomized (2:1) to a walking exercise
group (n=36) or a control comparison group (n=18). Veterans in the exercise group will
participate in a 12-week, instructor-led, outdoor brisk walking exercise program conducted in
small groups (n=6), held 3 times per week, gradually increasing walking time until reaching a
maximum of 40-minutes per session. The heart rate of each Veteran will be monitored during
the walking sessions to help ensure maintenance of a target peak heart rate of 60% to 70% of
the maximum for the individual's age (i.e., 220-age). Veterans in the control group will
participate in instructor-led, non-aerobic stretching exercises in small groups (n=6) with
the duration, frequency, and total number of sessions matched to the exercise group. Primary
outcome measures of cardiorespiratory fitness, cognition, and positive and negative affect of
participants in both groups will be measured at baseline and the 12-week end-point
assessment.

Inclusion Criteria:

- Diagnostic and Statistical Manual (DSM) - 5 diagnosis of schizophrenia or
schizoaffective disorder;

- age 40-65;

- screened for physical health risks (i.e., no serious heart condition, dizziness, bone
or joint problems posing safety concerns, ambulatory limitations);

- clinically stable (e.g., no inpatient hospitalizations for 3 months prior to
enrollment; no change in type of antipsychotic medication in the past 4 weeks)

Exclusion Criteria:

- evidence of alcohol or substance use disorder (moderate or greater severity) per DSM-5
criteria in the past 3 months;

- clinically significant neurological disease as determined by medical history (e.g.,
seizure disorder);

- history of serious head injury with loss of consciousness >1 hour;

- participation in an exercise program within past 6 months;

- not able to understand spoken and written English sufficiently to comprehend consent
procedures.