Optimal exercise dose and type for improving schizophrenia symptoms in adults: A systematic review and Bayesian network meta-analysis

• Published in: Neuroscience and biobehavioral reviews Vol. 167; p. 105896
• Main Authors: Yang, Yong, Yuan, Yuan, Zhang, HaoYang, Fu, XueYing, Wang, Tao, Wang, JunYu, Fang, Chu-Chun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.12.2024
• Subjects: Clinical symptoms; Dose-response; Exercise; Network meta-analysis; Schizophrenia; Schizophrenia; Dose-response; Network meta-analysis; Clinical symptoms; Exercise; dose-response; schizophrenia; clinical symptoms
• ISSN: 0149-7634; 1873-7528; 1873-7528
• DOI: 10.1016/j.neubiorev.2024.105896

Exercise has shown promise in aiding patients with schizophrenia, potentially improving symptoms, quality of life, mood, and cognition. This review evaluates the effectiveness of different physical activities in this context, aiming to guide treatment and research towards the most beneficial exercise interventions for schizophrenia management. This systematic review and network meta-analysis searched PubMed, MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Web of Science, and CNKI up to March 30, 2024. We utilized the "gemtc," "MBNMAdose," "metafor," and "ggplot2" packages for data analysis in R. Additionally, our results were reported as standardized mean differences with 95 % confidence intervals. To assess the risk of bias in the included studies, we used ROB2 and CINeMA tools. In the results section of our systematic review and network meta-analysis, we analyzed data from 47 studies involving 4031 participants. Our findings indicate that among the various exercise interventions examined for schizophrenia patients, yoga emerged as the most effective in improving Total symptoms, positive and negative symptoms. RT+AE (Resistance Training + Aerobic Exercise) showed the greatest improvement in general symptoms, whereas Tai Chi (TC) was the least effective. In terms of improvement of cognitive functions and depression, AE proved the most beneficial, while TC was found to be the least effective. EX+PT (Physical Exercise + Psychological Nursing) was identified as the most effective approach for improved quality of life, with TC again showing the least efficacy. The optimal total exercise dose to improve the patient's total symptoms was estimated to be 1200 METs-min/week. (SMD: −0.956, 95 %Crl: −1.376 to −0.536). Yoga, RT+AE, EX+PT, and Baduanjin have demonstrated enhanced efficacy in alleviating clinical symptoms, quality of life, depressive states, and cognitive functions in patients with schizophrenia. We identified optimal overall exercise doses and provided exercise guidance recommendations for healthcare professionals. •Yoga is the most effective for improving schizophrenia symptoms and enhancing well-being, while combined exercises also boost overall symptoms and quality of life.•The optimal exercise dose for improving schizophrenia symptoms is 1200 METs-min/week, which can produce the most significant overall symptom relief effect.•This study provides evidence-based guidance for exercise prescription for patients with schizophrenia, highlighting the importance of customized exercise interventions and optimal doses for effective clinical outcomes.