Impact of Physical Exercise Alone or in Combination with Cognitive Remediation on Cognitive Functions in People with Schizophrenia: A Qualitative Critical Review
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Effectiveness of Physical Exercise on Cognition in Schizophrenia
3.2. Combination of Physical Exercise and Cognitive Remediation for Treating Cognition in Schizophrenia
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Year of Publication and Authors | Type of Study | Number of Included Studies (Total Number of Participants) | Summary |
---|---|---|---|
Vancampfort et al., 2012 [30] | Systematic Review | 10 (322) | In one study, STM (correlated to an increased hippocampal volume) is improved by both AE and SE. |
Dauwan et al., 2016 [31] | Meta-analysis | 17 (659) | In one study, exercise improved verbal STM by 34% (p < 0.05) and brain volume was increased by 12%. |
Firth et al., 2015 [32] | Meta-analysis | 29 (1109) | Only yoga seems to influence the subdomain of LTM (p < 0.05), and to have a trend towards significance for AT and EF (p = 0.08). |
Firth et al., 2017a [33] | Systematic Review | 16 (423) | Improvements in brain structure and connectivity are associated to exercise’s beneficial effects on cognition in SCZ. Some studies also found a positive correlation between BDNF and cognitive enhancements. |
Firth et al., 2017b [34] | Meta-analysis | 10 (385) | PE significantly improves cognition and “higher dosages” of PE and supervised PE are associated with larger improvements in global cognition. Moreover, PE is particularly beneficial for SC, WM, and AT. Finally, AE seems more effective than yoga. |
Li et al., 2018 [35] | Systematic Review | 7 (679) | In one RCT (n = 194, low quality), mindful exercise is significantly more effective than other forms of exercise in WM subtests (MD 0.39). |
Van der Stouwe et al., 2018 [36] | Systematic Review | 29 (4448) | The protective effects of exercise on the reduction of hippocampal volume and white matter tracts were similar for both SSD and HC and they showed a dose–response relationship, but the effects in people with SSD appear to be of reduced entity. |
Dauwan et al., 2021 [37] | Meta-analysis | 122 (7231) | PE was superior to TAU in improving AT and WM (p < 0.009), EF (p = 0.013), memory (p = 0.038), and PS (p = 0.003). Results were proven not to be age-dependent. |
Fernández-Abascal et al., 2021 [38] | Meta-analysis | 59 (4202) | Post-intervention benefit was found for many cognitive domains: STM and AT measured through the WAIS’ forward and backward DSTs showed a significant effect at the end of the intervention (p = 0.014 for the forward test and p < 0.001 for the backward test), although the effects did not persist at follow-up (p = 0.528 and p = 0.291, respectively). Furthermore, different studies explored other outcomes through different measures: through the RAVLT test (significant only for the STM); through the Corsi direct block span for visual STM (not significant); through the Penn computerized neurocognitive battery for attention, SM, and WM (several domains showed a significant improvement for both yoga and other types of exercise, some persisting at follow-up as well); through the WCST for EF (significant improvement); through the MCCB for AT, memory, and SC (improvements seen in the scores correlated to improvement in physical performances); through the NES test for motor and sequencing skills (showing improvement but not maintained at follow-up); and other miscellaneous tests for SP, WM, VeL, and ViL (only WM was significantly improved). Only two studies found no post-intervention effects on cognition. |
Year of Publication and Authors | Type of Study | Groups | Total Number of Participants (Diagnosis) | Summary |
---|---|---|---|---|
Tan and King, 2013 [39] | RCT | PE and CR | 70 (SCZ) | The CR group kept a greater improvement in all of neurocognitive tests when compared to the PE group (p < 0.05 for all tests). |
Oertel-Knöchel et al., 2014 [40] | RCT | CR+AE, CR+RT, WW | 51 (29 SCZ + 22 MDD) | Cognitive performances were improved in both treatment groups (CT+AE group better than CT+RT), particularly in the cognitive subdomains of SP (p < 0.001), WM (p = 0.01), and ViL (p = 0.004). Additionally, the results show that the improvement is greater in SCZ compared to MDD, suggesting that the combined intervention is even more effective in SCZ (p < 0.001). |
Malchow et al., 2015 [41] | Clinical Trial | PE, PE + CACR, TT + CACR | 65 (43 SCZ + 22 HC) | The performance in VLMT and WCST significantly improved in the PE + CACR group. The positive effects were not seen in the TT + CACR group. |
Nuechterlein et al., 2016 [42] | Pilot Study | CT&E, CT | 18 (recent onset SSD) | The ES for the improvement in the MCCB score was larger for CT&E patients when compared to CT patients: the largest differential gains that were seen for CT&E were SC (f = 0.65), WM (f = 0.50), SP (f = 0.38), and attention (f = 0.33). |
Choi et al., 2019 [43] | RCT | PE, CT, PE + CT | 85 (SCZ) | WM was improved in all intervention groups (vs. the CT only group) and mostly in the PE only group (p < 0.001). At follow-up instead, the only group still showing significant improvements in WM was the CT + PE group (p < 0.001). Moreover, concerning PS, the only group showing a more significant improvement (vs. other groups) was the PE only group (p < 0.001), whereas at follow-up, only the PE + CT group (p < 0.001). |
Nuechterlein et al., 2022 [44] | RCT | CT&E, CT | 47 (FEP) | PE + CT (compared to CT alone) provided faster gains in cognition and greater improvements in psychosocial functioning. Strong correlations were observed between cognitive gains at six months and proportion of PE completed (r = 0.56) and the number of homework PE sessions (r = 0.61). The transfer of cognitive improvement to real-world functioning appears to be related to the quantity of completed PE (r = 0.51), and to participation in both CT sessions (r = 0.46) and bridging groups (r = 0.56). |
Dai et al., 2022 [45] | RCT | CAE, AE, TAU | 82 (SCZ) | The CAE group had a significantly better performance in PS and cognitive flexibility when compared to the TAU and the AE groups (p < 0.05). |
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Deste, G.; Corbo, D.; Nibbio, G.; Italia, M.; Dell'Ovo, D.; Calzavara-Pinton, I.; Lisoni, J.; Barlati, S.; Gasparotti, R.; Vita, A. Impact of Physical Exercise Alone or in Combination with Cognitive Remediation on Cognitive Functions in People with Schizophrenia: A Qualitative Critical Review. Brain Sci. 2023, 13, 320. https://doi.org/10.3390/brainsci13020320
Deste G, Corbo D, Nibbio G, Italia M, Dell'Ovo D, Calzavara-Pinton I, Lisoni J, Barlati S, Gasparotti R, Vita A. Impact of Physical Exercise Alone or in Combination with Cognitive Remediation on Cognitive Functions in People with Schizophrenia: A Qualitative Critical Review. Brain Sciences. 2023; 13(2):320. https://doi.org/10.3390/brainsci13020320
Chicago/Turabian StyleDeste, Giacomo, Daniele Corbo, Gabriele Nibbio, Mauro Italia, Dario Dell'Ovo, Irene Calzavara-Pinton, Jacopo Lisoni, Stefano Barlati, Roberto Gasparotti, and Antonio Vita. 2023. "Impact of Physical Exercise Alone or in Combination with Cognitive Remediation on Cognitive Functions in People with Schizophrenia: A Qualitative Critical Review" Brain Sciences 13, no. 2: 320. https://doi.org/10.3390/brainsci13020320