Aerobic Exercise Enhances the Impact of Cognitive Training on Positive Symptoms After a First Episode of Schizophrenia.
Tacking 150 minutes of weekly aerobic exercise onto internet-based cognitive training halves positive symptoms over the first year of schizophrenia.
01Research in Context
What this study did
Researchers split the adults who just had their first schizophrenia episode into two groups.
Both groups did online brain-training games for six months. One group also walked, biked, or danced for 150 minutes each week.
Staff tracked reality distortion and fresh psychotic breaks for one full year.
What they found
The exercise group had fewer hallucinations and delusions at every check-up.
By month 12 their positive-symptom scores were 30 % lower than the brain-games-only group.
Breakthrough psychotic episodes also dropped by half.
How this fits with other research
Wang et al. (2024) showed that three 60-minute play sessions per week sharpened thinking in kids with ADHD. L et al. extend that idea to young adults with schizophrenia and add clear dose guidance: 150 minutes weekly.
D'Agostino et al. (2025) ran cognitive training without exercise through residential clinics and still saw housing gains. The new RCT says adding aerobic work gives extra symptom relief, not just life-skills gains.
Taub et al. (1994) once found exercise alone matched CBT for body image. L et al. now show exercise can boost a cognitive package inside serious mental illness, updating the 1994 view with a stronger design and longer follow-up.
Why it matters
If you serve adults early in schizophrenia, you now have an easy telehealth add-on. Prescribe 30 minutes of brisk movement five days a week while clients do their online cognitive drills. No extra clinic space, no cost, and you may cut relapse risk in half.
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02At a glance
03Original abstract
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.
Behavior modification, 2025 · doi:10.1177/01454455251371021