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HOW PHYSICAL EXERCISE CAN HELP INDIVIDUALS WITH SCHIZOPHRENIA

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Schizophrenia is among the most disabling mental illnesses.The main treatment options include medication and psychological therapy, but additional options are required to further improve symptoms.2
 
People with schizophrenia often suffer from poor physical health and from the side effects of antipsychotics, which pharmacotherapies and psychological therapies may not be able to treat.3
 
In looking for additional ways to improve schizophrenia symptoms, research has focused on the potential of physical exercise.The benefits of physical exercise are well-known, but how exactly does it help people with schizophrenia?

Benefits of exercise for schizophrenia

 
1. Improves cognitive functioning
Cognitive deficits, along with negative symptoms, are the most disabling aspects of schizophrenia that drug treatment does not treat adequately.Reserach from several studies, however, has shown that exercise has the potential to improve cognitive deficits in patients with schizophrenia. Compared to those who did not engage in physical activity, individuals who exercised weekly showed marked improvement in cognition, more specifically in three areas: working memory, attention/vigilance and social cognition.It has also been found that the more you exercise, the better the cognitive improvements will be.
 
2. Improves negative symptoms
Studies have looked to see how aerobic versus stretching exercises might impact the many of schizophrenia. In one study,for example, all participants exercised around 30 minutes three times a week for 12 weeks, but one group did aerobic exercise and the other group did stretching exercises. It was found that those who did aerobic exercise improved in all the examined areas significantly more than those who did stretching exercises. The improvements were still observable three months after the 12-week period and strikingly, negative symptoms even continued to improve. Also, the more severe negative symptoms were prior to the intervention, the better the improvements were. This is an important finding given that negative symptoms are harder to treat,6 so adding aerobic exercise to your weekly routine helps you live a more functional life.
 
3. Combats weight gain
Although antipsychotics are the first-line medication treatment for schizophrenia and while they produce marked symptom-improvements, they cause side-effects, including weight gain.7 By getting physically more active and engaging in aerobic exercise, weight gain can be controlled.3
 
4. Reduces physical illnesses
Side-effects of antipsychotics might contribute to the development of physical health issues, like diabetes, hypertension and cardiovascular diseases. 8 One study9 investigated whether walking or cycling to work reduces the risk of heart diseases. By following up participants for 5 years, it was found that the number of deaths and hospital admissions linked to heart diseases were significantly lower among those participants who walked or cycled to work every day versus among those, who chose a non-active transportation-mode (car, public transport). So, physical exercise helps counter antipsychotics’ side-effects so that people living with schizophrenia can have a longer, healthier life.


Which exercise is better?

Guidelines suggest that moderate-to-vigorous intensity aerobic exercise has pronounced physical health benefits10, as seen in the presented findings as well.
Moderate-intensity aerobic exercises include:

Brisk walking

Gardening

Dancing

Slow cycling

Vigorous-intensity aerobic exercises include:

Running

Swimming

Jumping rope

Fast cycling


How much exercise should you aim for?

According to NHS guidelines, 150 minutes of moderate or 75 minutes of vigorous exercise per week is recommended in order to experience positive health benefits.10 You do not need to do all 150/75 minutes at once, you can break it down into smaller amounts and spread your workouts throughout the week.


Getting started?

Don’t worry if you are just starting to get into exercising and cannot complete the recommended 150/75 minutes per week. The ultimate aim should be to form a habit, where consistency is key. Make small changes first and increase the amount of exercise progressively.
Easy ways to make small changes:

Walk to the shop instead of driving

Take the stairs instead of the lift

Walk instead of taking the bus

If you have a spare 10-15 minutes during your day, go for a brisk walk

References

  1. Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophr Res. 2009;110(1–3):1-23.
  2. Patel R, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39(9):638–45.
  3. Girdler SJ, Confino JE, Woesner ME. Exercise as a treatment for schizophrenia: a reviewPsychopharmacol Bull. 2019;49(1):56–69.
  4. Firth J, Stubbs B, Rosenbaum S, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systemic review and meta-analysis. Schizophr Bull. 2017;43(3):546–56.
  5. Wang PW, Lin HC, Su CY et al. Effect of aerobic exercise on improving symptoms of individuals with schizophrenia: a single blinded randomised control study. Front Psychiatry. 2018;9:167.
  6. Erhart SM, Marder SR, Carpenter WT. Treatment of schizophrenia negative symptoms: future prospects. Schizophr Bull. 2006;32(2):234–7.
  7. Dayabandara M, Hanwella R, Ratnatunga S et al. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017;13:2231–41.
  8. Casey DE, Haupt DW, Newcomer JW et al. Antipsychotic-induced weight gain and metabolic abnormalities: implications for increased mortality in patients with schizophrenia. J Clin Psychiatry. 2004;65:4­–18­.
  9. Celis-Morales CA, Lyall DM, Welsh P et al. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ. 2017;357:j1456.
  10. NHS. Exercise. (2019). Accessed January 2021
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