REVIEW OF: Nuechterlein KH et al, Psychol Med 2022;53(10):4751–4761

STUDY TYPE: Randomized clinical trial

Schizophrenia often impairs the mental processes involved in learning and comprehension, which can affect social and occupational capabilities. Cognitive training (CT), or cognitive remediation, shows modest improvements in cognition and functional outcomes. The role of aerobic exercise in enhancing these effects is less established.

This study assessed the impact of combining aerobic exercise with CT on cognitive and functional outcomes. It involved 48 outpatients with a diagnosis of schizophrenia, all of whom had experienced their first psychotic episode. Patients were 18–45 years old (average 22 years), were predominantly male (70%), had an average of 13 years of education, and were mostly unemployed (43 out of 48). All were stabilized on antipsychotics and received weekly case management and group psychoeducation. After approximately three months, they were randomized into two groups: CT with aerobic exercise and CT alone.

The CT component involved 24 weeks of neurocognitive and social cognitive training, including two-hour computerized sessions twice weekly, followed by weekly group sessions to help apply the training in real-life situations. The aerobic exercise regimen, also spanning 24 weeks, consisted of two 45-minute in-clinic and two 30-minute home sessions weekly, aiming for 150 minutes of moderate aerobic activity per week. Sessions were group-based and were led by a certified trainer. Raters were not blind to intervention status.

The results showed significant cognitive improvements at three months (p=0.012) and better work/school functioning at six months (p<0.001) with the combined approach. These benefits did not extend to social functioning. For example, an individual might have noticed better task completion or less absenteeism at work or school but continued to face challenges in personal relationships and social interactions. Improvements correlated with exercise amount and participation in CT group sessions.

Carlat Take

Adding aerobic exercise to CT programs appears to significantly accelerate cognitive gains and enhance work/school functioning (but not social functioning) compared to CT alone. These findings underscore the importance of encouraging our patients to participate in exercise programs as a complement to traditional treatments—although, realistically, motivating patients to participate consistently can be a significant ­challenge.