97. Adding Aerobic Exercise to Cognitive Training Improves Negative Symptoms and Social Functioning in First-Episode Schizophrenia: An Initial RCT

摘要

>Background: Meta-analyses have shown that various forms of exercise in schizophrenia patients are associated with symptom reduction, improved quality of life, and increased levels of functioning. We examined whether combining cognitive training and aerobic exercise could improve symptoms and social functioning in first episode schizophrenia patients more effectively than cognitive training alone. Some evidence would indicate that intervening during this early phase of psychosis might be especially beneficial for maximizing treatment effects. >Methods: In this RCT, 46 patients with a first episode of schizophrenia were assigned to Cognitive Training plus Exercise (CT&E: n = 23) or Cognitive Training alone (CT; n = 23) for 6 months. Both groups received 24 weeks of cognitive training, 4 hours per week. The CT&E group, in addition to CT, participated in aerobic exercise, 150 minutes per week. The first 12 weeks involved neurocognitive training (BrainHQ). The second 12 weeks involved social cognitive training (SocialVille). The aerobic conditioning exercises included 45 minutes at UCLA two days a week and 30 minutes at home two days a week. Intensity of aerobic exercise was tailored to maintain an individualized target heart rate zone. A weekly one-hour Bridging Skills Group was used to aid generalization of training to everyday life situations. Negative symptoms were assessed every two weeks with the BPRS and every 3 months with the SANS. The Global Functioning Scale: Social was rated every 3 months. >Results: A Generalized Linear Mixed Model (GLMM) was used to compare the trajectories of changes in negative symptoms and social functioning. Analysis of the BPRS negative symptoms indicated that a significantly larger decrease in expressive negative symptoms occurred for patients in CT&E vs CT alone (F(1, 376) = 4.9, P = .03). SANS Blunted Affect also showed a differential decrease over time favoring CT&E (F(1, 30) = 4.1, P = .05). The SANS Avolition-Apathy domain also showed a differential effect of treatment favoring CT&E (F(1, 33) = 7.6, P = .01). Analysis of GFS Social showed a statistically significant difference in the trajectories of the two groups, again favoring CT&E (F(1, 38) = 4.1, P = .05). >Conclusion: Our preliminary findings support the use of exercise to boost the effects of cognitive training for reducing negative symptoms and improving social functioning. In particular, we found significant differential reductions on the BPRS negative symptom factor and on SANS Blunted Affect and Avolition/Apathy. The enhancing effect of adding exercise to cognitive training appears to extend the beneficial effects beyond cognitive gains alone. Promoting exercise interventions in first episode patients might lead to early gains that could promote recovery. >Funding source: R34MH102529 and P50MH066286