Aerobic Exercise Enhances the Impact of Cognitive Training on Positive Symptoms After a First Episode of Schizophrenia

We examined the effects of combining cognitive training plus aerobic exercise versus cognitive training alone on positive symptoms in recent-onset schizophrenia patients. Sixty-eight participants were randomly assigned to Cognitive Training plus Exercise (CT&E, N = 37) or Cognitive Training alone (CT, N = 31). All participants were also randomly assigned to either oral risperidone or paliperidone palmitate (PP1M) in a concurrent antipsychotic medication study. All participants were provided four weekly sessions of internet-based cognitive training conducted in a group format for 6 months, during which half were randomized to receive a 150 min/week aerobic exercise program. Then participants received 6 additional months of treatment at half of the psychosocial intervention frequency. Reality Distortion, the mean of BPRS ratings of Unusual Thought Content and Hallucinations, was averaged over all available BPRSs during the 3-month pre-baseline period and over four 3-month time periods during the 12 months of intervention. The proportion of BPRS administrations wherein either Unusual Thought Content or Hallucinations was rated >4 was used as a measure of breakthrough psychotic symptoms. Reality Distortion significantly decreased over time for the CT&E group compared to the non-Exercise (CT) group, F (4, 208) = 2.9, p = .02. The proportion of BPRS ratings with breakthrough symptoms decreased over successive 3-month periods for the CT&E group compared to the CT group, F (4, 218) = 6.9, p < .0001. The two medication groups did not significantly differ on either positive symptom outcome, and there were no three-way interactions. Our findings suggest that the enhancing effect of adding aerobic exercise to cognitive training extends beyond cognitive gains and includes positive psychotic symptoms.