Exercise therapy for schizophrenia

Paul Gorczynski; Guy Faulkner

doi:10.1002/14651858.CD004412.pub2

Terapia de ejercicios para la esquizofrenia

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Referencias

References to studies included in this review

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Beebe LH, Tian L, Morris N, Goodwin A, Allen SS, Kuldau J. Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in Mental Health Nursing 2005;26(6):661‐76. [PUBMED: 16020076]

Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add‐on treatment in the management of patients with schizophrenia ‐ a randomized controlled trial. Acta Psychiatrica Scandinavica 2007;116(3):226‐32. [PUBMED: 17655565]

Marzaloni S, Jensen B, Melville P. Feasibility and effects of a group‐based resistance and aerobic exercise program for individuals with schizophrenia: a multidisciplinary approach. Mental Health and Physical Activity 2009;2(1):29‐36.

References to studies excluded from this review

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Acil, A A, Dogan, S, Dogan, O. The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of Psychiatric and Mental Health Nursing 2008;15:808‐15.

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Hu Q‐L, Xue L‐H, Gao X‐H. Effect of music‐sport therapy on the insight and behavioral disturbance in patients with schizophrenia. Zhongguo Linchuang Kangfu 2004;8(9):1626‐27.

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Li M, Wang H, Li X. Effect of music and sport therapy as assistant treatment for schizophrenia. Heilongjiang Nursing Journal 2005;11(20):1677‐78.

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References to studies awaiting assessment

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Lin MR. The effect of 'sit ups' on constipation in patients with schizophrenia. International Journal of Nursing 2006;25(1):58‐9.

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Nilsberg G. Aerobic endurance training and effect on symptoms of schizophrenia. http://www.clinicaltrials.gov2006.

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Ning XH, Chen YX, Lu F. The effect of jianshen gymnastics on the negative symptoms of schizophrenia. Chinese journal of Behavioral Medical Science 2003;7478(3):329.

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Scheidhacker M, Bender W, Vaitl P. The efficacy of horse‐riding in the treatment of chronic schizophrenic patients [Die wirksamkeit des therapeutischen reitens bei behandlung chronisch schizophrener patienten: experimentelle ergebnisse und klinische erfahrungen]. Nervenarzt 1991;62:283‐7.

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References to ongoing studies

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Lindamer L, Delapena J. Adapting a physical activity intervention for schizophrenia. http://www.clinicaltrials.gov2006.

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Beebe 2005

Methods	Allocation: randomised. Blinding: single. Duration: 16 weeks. Setting: Veterans Affairs Hospital, USA.
Participants	Diagnosis: schizophrenia (DSM‐IV). N=12. Age: mean ˜ 52 years. Sex: 8M, 2F.
Interventions	1. Exercise Group: exercise programme 3x a week. 10 minute warm up stretches in addition to walking on a treadmill; participants increased their walking time from 5 minutes on the first day to 30 minutes. N=6. 2. Standard care: participants continued usual care and were placed on waiting list and then received identical intervention at the conclusion of the study. N=6. Data was taken only from the time participants received standard care.
Outcomes	Mental state: PANSS positive, negative score. Leaving study early. Unable to use ‐ Mental state: PANSS total score (SDs not reported). Physical fitness: Six Minute Walk Test (SDs not reported). Weight: BMI, Percentage body fat (SDs not reported ‐ some data for percentage body fat presented as other data).
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Allocation schedule designed by statistician.
Allocation concealment?	Unclear risk	No details given.
Blinding? All outcomes	Low risk	Single, researcher blinded to group status, untested.
Incomplete outcome data addressed? All outcomes	High risk	83.3% of participants in the analysis (10/12). Two participants in the exercise arm did not attend first session. These participants were excluded from the results.
Free of selective reporting?	High risk	Several SDs were not reported for PANSS, BMI, and Percentage Body Fat.
Free of other bias?	High risk	Small sample size.

Duraiswamy 2007

Methods	Allocation: randomised. Blinding: single. Duration: 15 weeks. Setting: National Institute of Mental Health and Neuro Sciences, Bangalore, India.
Participants	Diagnosis: schizophrenia, any subtype, DSM‐IV. N=61. Age: mean ˜ 31 years. Sex: 42M, 19F.
Interventions	1. Exercise Group: brisk walking, jogging, exercises in standing and sitting postures and relaxation. Participants underwent three weeks of training and then continued with the programme for the remaining three months. Participants met for 1 hour a day, 5 days a week. N=30. 2. Other treatment: yoga with breathing practice and relaxation techniques. Participants underwent three weeks of training and then continued with the programme for the remaining three months. Participants met for 1 hour a day, 5 days a week. N=31.
Outcomes	Mental State: PANSS positive, negative, depression, anergia, total score. General Functioning: SOFS score. Adverse effects: SAS, AIMS total score. Qualty of Life: World Health Organization Quality of LIfe BREF version ‐ psychological, physical, social and environmental QofL. Unable to use ‐ Qualty of Life: World Health Organization Quality of LIfe BREF version ‐ total Qofl (score not reported).
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Computer generated.
Allocation concealment?	Unclear risk	No details given.
Blinding? All outcomes	Low risk	Single, researcher blinded to group status, untested.
Incomplete outcome data addressed? All outcomes	High risk	67.2% of participants in the analysis (41/61). Then participants in each study arm left early because of disinterest and long distance from hospital. These participants were excluded from the results.
Free of selective reporting?	High risk	Quality of life total data not reported.
Free of other bias?	High risk	No true control group used. Exercise compared with yoga. Same therapist delivered both conditions.

Marzaloni 2008

Methods	Allocation: randomised. Blinding: unknown. Duration:12 weeks. Setting: community centre, Toronto, Canada.
Participants	Diagnosis: schizophrenia, any subtype, DSM‐IV. N=13. Age: mean ˜ 45 years. Sex: 8M, 5F.
Interventions	1. Exercise Group: each session consisted of a 10 minute warm‐up, 20 minutes of resistance weight training, 60 minutes of aerobic training, and a 5 minute cool‐down. Participants met twice a week for 12 weeks. Each session was 90 minutes in length. Participants were encouraged to exercise one additional time per week on their own. N=7. 2. Standard care: continued usual care; no further details were provided. N=6.
Outcomes	Mental state: Mental Health Inventory (MHI) ‐ total, depression, positive affect, behavioral, anxiety scores. Physical fitness: Six Minute Walk Test, maximum strength. Satisfaction with treatment: Satisfaction and Feedback survey. Leaving study early. Unable to use ‐ Weight: BMI, resting blood, waist and hip circumferences (data not reported).
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Two options for group assignments were identified on an equal number of identical cards and blindly chosen from a selection box.
Allocation concealment?	Low risk	Random draw by an independent observer uninvolved in the study.
Blinding? All outcomes	Unclear risk	Single, researcher blinded to group status, untested.
Incomplete outcome data addressed? All outcomes	Low risk	100% of participants in the analysis (13/13).
Free of selective reporting?	High risk	Not all anthropometric measurements were reported.
Free of other bias?	High risk	Small sample size.

Characteristics of excluded studies [author‐defined order]

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Study	Reason for exclusion
Acil 2008	Allocation: quasi‐experimental design.
Adams 2001	Allocation: unclear.
Apter 1978	Allocation: randomised. Participants: uncertain how many individuals were diagnosed with schizophrenia.
Hu 2004	Allocation: randomised. Participants: schizophrenia. Intervention: included both music and sports therapy.
Li 2005	Allocation: randomised. Participants: schizophrenia. Intervention: included both music and sports therapy.
Liu 2006	Allocation: randomised. Participants: schizophrenia. Intervention: Drug trial, no exercise or physical activity.
Skrinar 2005	Allocation: randomised. Participants: less than 50% of the participants had a diagnosis of schizophrenia.
Su 1999	Allocation: randomised. Participants:schizophrenia. Intervention: included both music and sports therapy.
Wu 2008	Allocation: randomised. Participants: schizophrenia. Intervention: lifestyle components included physical activity and diet modification. Not possible to clearly link physical activity to mental health outcomes.
Wu 2007	Allocation: randomised Participants: schizophrenia. Intervention: lifestyle component included physical activity and diet modification. Not possible to clearly link physical activity to mental health outcomes.

Characteristics of studies awaiting assessment [ordered by study ID]

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Lin 2006

Methods	Allocation: randomised. Blinding: unclear, no details provided. Duration: Unclear, no details provided. Setting: China.
Participants	Diagnosis: schizophrenia. N=60. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Exercise Therapy Group: unclear, no details provided. N=30. Standard Care Group: unclear, no details provided. N=30.
Outcomes	Unclear, no details provided.
Notes	Paper needs to be translated.

NCT00286299

Methods	Allocation: randomised. Blinding: unclear, no details provided. Duration: unclear, no details provided. Setting: unclear, no details provided.
Participants	Diagnosis: schizophrenia (ICD 10, F20). N=40. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Physical activity Group: unclear, no details provided. Control Group: unclear, no details provided.
Outcomes	Mental State. PANSS. General Functioning. Short‐form Health Survey‐36.
Notes	Details being sought from author.

Ning 2003

Methods	Allocation: randomised. Blinding: unclear, no details provided. Duration: unclear, no details provided. Setting: China.
Participants	Diagnosis: schizophrenia. N=80. Age: unclear, no details provided. Sex: 80F.
Interventions	Jianshen Gymnastics Group: Jianshen gymnastics and common treatment. Control Group: Common treatment.
Outcomes	Mental state. PANSS, SANS. Behaviour. NOSIE.
Notes	Paper needs to be translated.

Scheidhacker 1991

Methods	Allocation: randomised. Blinding: unclear, no details provided. Duration: Unclear, no details provided. Setting: Germany.
Participants	Diagnosis: schizophrenia. N = unclear, no details provided. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Horse Riding Group: Unclear, no details provided. Control Group: Unclear, no details provided.
Outcomes	Unclear, no details provided.
Notes	Paper needs to be translated.

Wu 2007b

Methods	Allocation: randomised. Blinding: unclear. Duration: unclear, no details provided. Setting: China.
Participants	Diagnosis: Schizophrenia. N=128. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Exercise Therapy: unclear, no details provided. Standard Care: unclear, no details provided.
Outcomes	Mental State. PANSS. General Functioning. IPROS. Behaviour. NOSIE. Leaving study early.
Notes	Paper needs to be translated to obtain further details.

Xie 2006

Methods	Allocation: randomised. Blinding: unclear, no details provided. Duration: unclear, no details provided. Setting: working and Entertainment Treatment Room, Mental Health Centre of Shantou University, Shantou, China.
Participants	Diagnosis: schizophrenia. N=80. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Yoga Group: yoga exercises for 8 weeks in addition to antipsychotic treatment. N=38. Control Group: N=42.
Outcomes	Quality of Life.
Notes	Paper needs to be translated to obtain further details.

Zhang 2006

Methods	Allocation: randomised. Blinding: unclear. Duration: unclear, no details provided. Setting: China.
Participants	Diagnosis: schizophrenia. N=58. Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Exercise Therapy: unclear, no details provided. Standard Care: unclear, no details provided.
Outcomes	Nurses' observation scale for inpatient evaluation (NOSIE).
Notes	Paper needs to be translated to obtain further details.

Characteristics of ongoing studies [ordered by study ID]

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NCT00338832

Trial name or title	Effectiveness of a lifestyle intervention for increasing physical activity in adults with schizophrenia.
Methods	Allocation: randomised. Blinding: single. Duration: unclear, no details provided. Setting: San Diego, CA.
Participants	Diagnosis: schizophrenia. N = 86 (expected enrolment). Age: unclear, no details provided. Sex: unclear, no details provided.
Interventions	Physical activity and leisure Group: 90 minute sessions conducted weekly for the first 16 weeks, then biweekly for the following 8 weeks. Sessions will focus on short and long term goals, learning about physical activity, and playing leisure activities (e.g., board games). Participants will also have opportunities to socialise with each other. Control Group: unclear, no details provided.
Outcomes	Physical Fitness. Cardiovascular Measures. Weight. BMI. Qualifty of Life.
Starting date	June 2006.
Contact information	Laurie Lindamer UC San Diego 858 552 8585 x3870 [email protected]
Notes

Data and analyses

Open in table viewer

Comparison 1. COMPARISON 1: EXERCISE versus STANDARD CARE

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mental state 1a: Mental Health Inventory Total ‐ Endpoint score: high score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

7.40 [‐2.46, 17.26]

Analysis 1.1

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 1 Mental state 1a: Mental Health Inventory Total ‐ Endpoint score: high score good.

2 Mental State 1b: Mental Health Inventory Depression ‐ Endpoint: high score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

17.5 [6.70, 28.30]

Analysis 1.2

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 2 Mental State 1b: Mental Health Inventory Depression ‐ Endpoint: high score good.

3 Mental state 1c: Mental Health Inventory Positive Affect ‐ Endpoint: high score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

3.30 [‐23.66, 30.26]

Analysis 1.3

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 3 Mental state 1c: Mental Health Inventory Positive Affect ‐ Endpoint: high score good.

4 Mental state 1d: Mental Health Inventory Behavioural ‐ Endpoint: high score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

‐5.40 [‐21.28, 10.48]

Analysis 1.4

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 4 Mental state 1d: Mental Health Inventory Behavioural ‐ Endpoint: high score good.

5 Mental state 1e: Mental Health Inventory Anxiety ‐ Endpoint: high score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

8.0 [0.80, 15.20]

Analysis 1.5

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 5 Mental state 1e: Mental Health Inventory Anxiety ‐ Endpoint: high score good.

6 Mental state 2a: PANSS Negative ‐ Endpoint: low score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

‐8.5 [‐11.11, ‐5.89]

Analysis 1.6

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 6 Mental state 2a: PANSS Negative ‐ Endpoint: low score good.

7 Mental state 2b: PANSS Positive ‐ Endpoint: low score good Show forest plot

1

10

Mean Difference (IV, Fixed, 95% CI)

‐2.5 [‐4.73, ‐0.27]

Analysis 1.7

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 7 Mental state 2b: PANSS Positive ‐ Endpoint: low score good.

8 Physical fitness 1: Six minute walking test ‐ Endpoint: High score good Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

79.50 [33.82, 125.18]

Analysis 1.8

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 8 Physical fitness 1: Six minute walking test ‐ Endpoint: High score good.

9 Physical fitness 2: Maximal strength ‐ Endpoint: High score good Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

2.0 [0.55, 3.45]

Analysis 1.9

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 9 Physical fitness 2: Maximal strength ‐ Endpoint: High score good.

10 Physical Fitness 3: Cardiovascular measures 1: Blood pressure Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐8.05, 6.05]

Analysis 1.10

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 10 Physical Fitness 3: Cardiovascular measures 1: Blood pressure.

11 Weight 1: BMI Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐2.92, 0.52]

Analysis 1.11

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 11 Weight 1: BMI.

12 Weight 2: Percentage body fat Show forest plot

Other data

No numeric data

Analysis 1.12


Study	Exercise Group	Standard care Group
Beebe 2005	reduced body fat by 3.7%	reduced body fat by 0.02%

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 12 Weight 2: Percentage body fat.

13 Weight 3: Waist and Hip Ratio Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.02, 0.04]

Analysis 1.13

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 13 Weight 3: Waist and Hip Ratio.

14 Weight 4: Final Weight Show forest plot

1

13

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐3.64, 6.24]

Analysis 1.14

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 14 Weight 4: Final Weight.

15 Leaving the study early Show forest plot

2

25

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.29, 86.43]

Analysis 1.15

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 15 Leaving the study early.

Open in table viewer

Comparison 2. COMPARISON 2: EXERCISE versus OTHER TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental state 1a: PANSS Total ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	14.95 [2.60, 27.30]
Open in figure viewer Analysis 2.1 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 1 Mental state 1a: PANSS Total ‐ Endpoint: low score good.
2 Mental state 1b: PANSS Depression ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.89 [0.86, 4.92]
Open in figure viewer Analysis 2.2 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 2 Mental state 1b: PANSS Depression ‐ Endpoint: low score good.
3 Mental state 1c: PANSS Anergia ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.40 [0.47, 4.33]
Open in figure viewer Analysis 2.3 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 3 Mental state 1c: PANSS Anergia ‐ Endpoint: low score good.
4 Mental state 1d: PANSS Positive ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.41 [‐1.20, 6.02]
Open in figure viewer Analysis 2.4 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 4 Mental state 1d: PANSS Positive ‐ Endpoint: low score good.
5 Mental state 1d: PANSS Negative ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	5.56 [1.69, 9.43]
Open in figure viewer Analysis 2.5 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 5 Mental state 1d: PANSS Negative ‐ Endpoint: low score good.
6 General functioning 1: SOFS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	4.35 [‐1.18, 9.88]
Open in figure viewer Analysis 2.6 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 6 General functioning 1: SOFS ‐ Endpoint: low score good.
7 Adverse effects 1: SAS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐0.44, 1.44]
Open in figure viewer Analysis 2.7 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 7 Adverse effects 1: SAS ‐ Endpoint: low score good.
8 Adverse effects 2: AIMS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐1.18, 1.58]
Open in figure viewer Analysis 2.8 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 8 Adverse effects 2: AIMS ‐ Endpoint: low score good.
9 Quality of life 1a: WHOQOL‐100 Physical ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐9.22 [‐18.86, 0.42]
Open in figure viewer Analysis 2.9 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 9 Quality of life 1a: WHOQOL‐100 Physical ‐ Endpoint: High score good.
10 Quality of life 1b: WHOQOL‐100 Psychological ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐17.70 [‐28.90, ‐6.50]
Open in figure viewer Analysis 2.10 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 10 Quality of life 1b: WHOQOL‐100 Psychological ‐ Endpoint: High score good.
11 Quality of life 1c: WHOQOL‐100 Social ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐20.75 [‐34.08, ‐7.42]
Open in figure viewer Analysis 2.11 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 11 Quality of life 1c: WHOQOL‐100 Social ‐ Endpoint: High score good.
12 Quality of life 1d: WHOQOL‐100 Environmental ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐18.09 [‐28.52, ‐7.66]
Open in figure viewer Analysis 2.12 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 12 Quality of life 1d: WHOQOL‐100 Environmental ‐ Endpoint: High score good.
13 Leaving the study early Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.47, 1.88]
Open in figure viewer Analysis 2.13 Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 13 Leaving the study early.

Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 1 Mental state 1a: Mental Health Inventory Total ‐ Endpoint score: high score good.

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Analysis 1.2

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 2 Mental State 1b: Mental Health Inventory Depression ‐ Endpoint: high score good.

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Analysis 1.3

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 3 Mental state 1c: Mental Health Inventory Positive Affect ‐ Endpoint: high score good.

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Analysis 1.4

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 4 Mental state 1d: Mental Health Inventory Behavioural ‐ Endpoint: high score good.

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Analysis 1.5

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 5 Mental state 1e: Mental Health Inventory Anxiety ‐ Endpoint: high score good.

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Analysis 1.6

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 6 Mental state 2a: PANSS Negative ‐ Endpoint: low score good.

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Analysis 1.7

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 7 Mental state 2b: PANSS Positive ‐ Endpoint: low score good.

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Analysis 1.8

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 8 Physical fitness 1: Six minute walking test ‐ Endpoint: High score good.

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Analysis 1.9

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 9 Physical fitness 2: Maximal strength ‐ Endpoint: High score good.

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Analysis 1.10

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 10 Physical Fitness 3: Cardiovascular measures 1: Blood pressure.

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Analysis 1.11

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 11 Weight 1: BMI.

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Study	Exercise Group	Standard care Group
Beebe 2005	reduced body fat by 3.7%	reduced body fat by 0.02%

Analysis 1.12

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 12 Weight 2: Percentage body fat.

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Analysis 1.13

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 13 Weight 3: Waist and Hip Ratio.

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Analysis 1.14

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 14 Weight 4: Final Weight.

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Analysis 1.15

Comparison 1 COMPARISON 1: EXERCISE versus STANDARD CARE, Outcome 15 Leaving the study early.

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Analysis 2.1

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 1 Mental state 1a: PANSS Total ‐ Endpoint: low score good.

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Analysis 2.2

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 2 Mental state 1b: PANSS Depression ‐ Endpoint: low score good.

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Analysis 2.3

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 3 Mental state 1c: PANSS Anergia ‐ Endpoint: low score good.

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Analysis 2.4

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 4 Mental state 1d: PANSS Positive ‐ Endpoint: low score good.

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Analysis 2.5

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 5 Mental state 1d: PANSS Negative ‐ Endpoint: low score good.

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Analysis 2.6

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 6 General functioning 1: SOFS ‐ Endpoint: low score good.

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Analysis 2.7

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 7 Adverse effects 1: SAS ‐ Endpoint: low score good.

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Analysis 2.8

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 8 Adverse effects 2: AIMS ‐ Endpoint: low score good.

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Analysis 2.9

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 9 Quality of life 1a: WHOQOL‐100 Physical ‐ Endpoint: High score good.

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Analysis 2.10

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 10 Quality of life 1b: WHOQOL‐100 Psychological ‐ Endpoint: High score good.

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Analysis 2.11

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 11 Quality of life 1c: WHOQOL‐100 Social ‐ Endpoint: High score good.

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Analysis 2.12

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 12 Quality of life 1d: WHOQOL‐100 Environmental ‐ Endpoint: High score good.

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Analysis 2.13

Comparison 2 COMPARISON 2: EXERCISE versus OTHER TREATMENT, Outcome 13 Leaving the study early.

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Comparison 1. COMPARISON 1: EXERCISE versus STANDARD CARE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental state 1a: Mental Health Inventory Total ‐ Endpoint score: high score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	7.40 [‐2.46, 17.26]

2 Mental State 1b: Mental Health Inventory Depression ‐ Endpoint: high score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	17.5 [6.70, 28.30]

3 Mental state 1c: Mental Health Inventory Positive Affect ‐ Endpoint: high score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	3.30 [‐23.66, 30.26]

4 Mental state 1d: Mental Health Inventory Behavioural ‐ Endpoint: high score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	‐5.40 [‐21.28, 10.48]

5 Mental state 1e: Mental Health Inventory Anxiety ‐ Endpoint: high score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	8.0 [0.80, 15.20]

6 Mental state 2a: PANSS Negative ‐ Endpoint: low score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	‐8.5 [‐11.11, ‐5.89]

7 Mental state 2b: PANSS Positive ‐ Endpoint: low score good Show forest plot	1	10	Mean Difference (IV, Fixed, 95% CI)	‐2.5 [‐4.73, ‐0.27]

8 Physical fitness 1: Six minute walking test ‐ Endpoint: High score good Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	79.50 [33.82, 125.18]

9 Physical fitness 2: Maximal strength ‐ Endpoint: High score good Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	2.0 [0.55, 3.45]

10 Physical Fitness 3: Cardiovascular measures 1: Blood pressure Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐8.05, 6.05]

11 Weight 1: BMI Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	‐1.20 [‐2.92, 0.52]

12 Weight 2: Percentage body fat Show forest plot			Other data	No numeric data

13 Weight 3: Waist and Hip Ratio Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.02, 0.04]

14 Weight 4: Final Weight Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	1.30 [‐3.64, 6.24]

15 Leaving the study early Show forest plot	2	25	Risk Ratio (M‐H, Fixed, 95% CI)	5.0 [0.29, 86.43]

Comparison 1. COMPARISON 1: EXERCISE versus STANDARD CARE

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Comparison 2. COMPARISON 2: EXERCISE versus OTHER TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental state 1a: PANSS Total ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	14.95 [2.60, 27.30]

2 Mental state 1b: PANSS Depression ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.89 [0.86, 4.92]

3 Mental state 1c: PANSS Anergia ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.40 [0.47, 4.33]

4 Mental state 1d: PANSS Positive ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	2.41 [‐1.20, 6.02]

5 Mental state 1d: PANSS Negative ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	5.56 [1.69, 9.43]

6 General functioning 1: SOFS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	4.35 [‐1.18, 9.88]

7 Adverse effects 1: SAS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐0.44, 1.44]

8 Adverse effects 2: AIMS ‐ Endpoint: low score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐1.18, 1.58]

9 Quality of life 1a: WHOQOL‐100 Physical ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐9.22 [‐18.86, 0.42]

10 Quality of life 1b: WHOQOL‐100 Psychological ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐17.70 [‐28.90, ‐6.50]

11 Quality of life 1c: WHOQOL‐100 Social ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐20.75 [‐34.08, ‐7.42]

12 Quality of life 1d: WHOQOL‐100 Environmental ‐ Endpoint: High score good Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐18.09 [‐28.52, ‐7.66]

13 Leaving the study early Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.47, 1.88]

Comparison 2. COMPARISON 2: EXERCISE versus OTHER TREATMENT

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Referencias

References to studies included in this review

Beebe 2005 {published data only}

Duraiswamy 2007 {published data only}

Marzaloni 2008 {published data only}

References to studies excluded from this review

Acil 2008 {published data only}

Adams 2001 {published data only}

Apter 1978 {published data only}

Hu 2004 {published data only}

Li 2005 {published data only}

Liu 2006 {published data only}

Skrinar 2005 {published data only}

Su 1999 {published data only}

Wu 2007 {published data only}

Wu 2008 {published data only}

References to studies awaiting assessment

Lin 2006 {published data only}

NCT00286299 {published data only}

Ning 2003 {published data only}

Scheidhacker 1991 {published data only}

Wu 2007b {published data only}

Xie 2006 {published data only}

Zhang 2006 {published data only}

References to ongoing studies

NCT00338832 {published data only}

Additional references

Altman 1996

Begg 1996

Bland 1997

Boissel 1999

Boutron 2004

Brown 1999

Caspersen 1985

Chamove 1986

Davidson 2001

Deeks 2000

Divine 1992

Donner 2002

DSM‐IV 1994

Egger 1997

Ellis 2007

Enright 1998

Faulkner 1999

Faulkner 2005

Faulkner 2005b

Faulkner 2006

Goff 2005

Gulliford 1999

Higgins 2003

Higgins 2008

Jüni 2001

Kay 1986

Lambert 2003

Lykouras 2008

Marshall 2000

McGrath 2008

Meyer 2003

Moher 2001

Munetz 1988

Mutrie 2003

Saraswat 2006

Schulz 2001

Simpson 1970

Skevington 2004

Ukoumunne 1999

Veit 1983

Ware 1998

Xia 2007

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [author‐defined order]

Characteristics of studies awaiting assessment [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Data and analyses

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