Yoga appeared to be the most effective exercise for schizophrenia symptom control, according to a recent systematic review and meta-analysis.

A recently published systematic review and meta-analysis found that yoga is the most effective form of physical exercise for schizophrenia symptom reduction. The review also aimed to establish the optimal dose of exercise for managing the condition.

Previous studies have shown that exercise can help people with schizophrenia manage their symptoms, Yong Yang and colleagues explained in Neuroscience & Biobehavioral Reviews.

“Exercise stands as an effective avenue for the amelioration of clinical symptoms in schizophrenia. However, determining the distinct superiority among various physical activities remains complex through the utilization of randomized clinical trials or pairwise meta-analyses,” the researchers wrote. “Consequently, selecting the most efficacious exercise intervention to enhance clinical outcomes in individuals with schizophrenia poses a challenging quandary for both clinicians and patients.”

Exercise Types & Their Impact

The researchers performed a systematic review and Bayesian model-driven dose-response network meta-analysis to examine trials of 10 different types of exercise, gathering articles from the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, EMBASE, Medline, PubMed, and PsycINFO databases.

To be included, studies needed to focus on patients with a schizophrenia diagnosis, divide exercises by type, and have a usual care (control) group. Studies also were required to report data for the primary outcome, which was total symptom change. Secondary outcomes were positive, negative, and depressive symptoms of schizophrenia as well as QOL and cognitive level.

The researchers excluded articles that involved patients who did not have baseline schizophrenia, studied the acute effects of a single exercise session, or did not clearly describe the type of exercise or dose.

Yang and colleagues ultimately included 47 articles spanning 4,031 participants. All studies were published between 2005 and 2022. Most patients were male (n=2,398, 59.48% vs n=1,633, 40.52% female). The treatment periods ranged from 4-96 weeks, and the median treatment duration was 12 weeks.

The analysis showed that yoga was the most effective exercise regimen, reducing overall symptoms and both positive and negative symptoms. However, yoga was not the most effective exercise in the domain of “general symptoms.”

Other exercises were effective in specific areas. The researchers reported that resistance training paired with aerobic exercise produced the greatest improvement in general symptoms, whereas Tai Chi was the least effective. Aerobic exercise was the most effective for improving depression and cognitive function, though here again, Tai Chi was reportedly the least effective.

Physical exercise with added psychological nursing appeared to be the most effective exercise in improving patients’ QOL, whereas Tai Chi was the least effective. Baduanjin, a movement and meditation practice, also appeared effective in improving symptoms and QOL.

There was a nonlinear dose-response relationship between the patient’s overall level of exercise and total symptoms. Yang and colleagues estimated that the optimum dose of exercise was 1,200 METs-min per week (standardized mean difference, −0.956; 95% Cl, -1.376 to -0.536).

New Insights on Exercise for Schizophrenia

The review had several limitations. The researchers’ lack of access to the full text of some clinical trials may have introduced bias to their findings. Other limitations included the heterogeneity of the studies and the fact that many patients with schizophrenia face barriers to exercise. Using METs to measure exercise intensity also has limitations, as they are based on the average person’s resting metabolic rate. Still, Yang and colleagues wrote that their review broke some new ground.

“By conducting a comprehensive analysis of data from 47 randomized controlled trials involving 4,031 patients with schizophrenia, we discovered that physical exercise significantly improves clinical symptoms, QOL, and cognitive function, and reduces depression indices,” Yang and colleagues wrote.

“These findings are consistent with previous systematic reviews and meta-analyses, further confirming the efficacy of physical exercise in the comprehensive treatment of schizophrenia. However, unlike previous studies, this research not only distinctly categorized the effects of different exercise interventions but also analyzed exercise dosages, filling a gap in the existing literature.”

Yang and colleagues also said their finding of an optimum 1,200 METs-min per week of exercise “was crucial for developing exercise guidelines for schizophrenia patients, especially in improving clinical symptoms, QOL, and reducing depression indices.”