Aerobic Exercise for Cognitive and Functional Enhancement in Schizophrenia: Evidence, Mechanisms, and Practical Recommendations

Schizophrenia is a psychiatric condition often characterized by cognitive deficits which precede the onset of positive symptoms and contribute significantly to enduring functional impairments and poor quality of life. Those cognitive deficits can have a profoundly negative impact on daily activities such as social relationships and work functioning. Although pharmacological interventions remain central to the treatment of schizophrenia (SZ), they have a negligible impact on cognitive functioning. Yet multiple reviews and meta-analyses support the hypothesis that Aerobic Exercise (AE) could serve as an adjunctive, therapeutic intervention for these cognitive impairments. AE is recommended for individuals with Multi-episode Psychosis (MEP) and with First Episode Psychosis (FEP). This body of evidence indicates that for individuals with SZ, engagement in AE shows measurable enhancements in specific brain regions associated with key domains of neurocognitive functioning. AE has also been associated with improvements in neurobiological processes including increased BDNF, enhanced neurogenesis, and improved neural connectivity. These improvements were linked to key cognitive domains associated daily functioning such as attention, working memory, reasoning, speed of processing, and social cognition. Engagement in AE has also been associated with improvements in Activities of Daily Living, reductions in psychiatric symptoms, improvements in psychosocial functioning, and good quality of life. Endorsements and specific guidelines have been published worldwide from leading governmental health agencies and international professional psychiatric organizations. These recommendations have been summarized so that practitioners can implement AE programs for individuals with SZ using group and/or individually tailored interventions to boost motivation and enhance self-efficacy for engaging in AE.