Skip to main content

Advertisement

SpringerLink
Log in

Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Cognitive deficits are core symptoms in patients with schizophrenia (SZ) and major depressive disorder (MDD), but specific and approved treatments for cognitive deterioration are scarce. Experimental and clinical evidence suggests that aerobic exercise may help to reduce psychopathological symptoms and support cognitive performance, but this has not yet been systematically investigated. In the current study, we examined the effects of aerobic training on cognitive performance and symptom severity in psychiatric inpatients. To our knowledge, to date, no studies have been published that directly compare the effects of exercise across disease groups in order to acquire a better understanding of disease-specific versus general or overlapping effects of physical training intervention. Two disease groups (n = 22 MDD patients, n = 29 SZ patients) that were matched for age, gender, duration of disease and years of education received cognitive training combined either with aerobic physical exercise or with mental relaxation training. The interventions included 12 sessions (3 times a week) over a time period of 4 weeks, lasting each for 75 min (30 min of cognitive training + 45 min of cardio training/mental relaxation training). Cognitive parameters and psychopathology scores of all participants were tested in pre- and post-testing sessions and were then compared with a waiting control group. In the total group of patients, the results indicate an increase in cognitive performance in the domains visual learning, working memory and speed of processing, a decrease in state anxiety and an increase in subjective quality of life between pre- and post-testing. The effects in SZ patients compared with MDD patients were stronger for cognitive performance, whereas there were stronger effects in MDD patients compared with SZ patients in individual psychopathology values. MDD patients showed a significant reduction in depressive symptoms and state anxiety values after the intervention period. SZ patients reduced their negative symptoms severity from pre- to post-testing. In sum, the effects for the combined training were superior to the other forms of treatment. Physical exercise may help to reduce psychopathological symptoms and improve cognitive skills. The intervention routines employed in this study promise to add the current psychopathological and medical treatment options and could aid the transition to a multidisciplinary approach. However, a limitation of the current study is the short time interval for interventions (6 weeks including pre- and post-testing).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Acil A, Dogan S, Dogan O (2008) The effects of physical exercises to mental state and quality of life in patients with schizophrenia. J Psychiatr Ment Health Nurs 15:808–815

    Article  PubMed  CAS  Google Scholar 

  2. Ali IM (1998) Long-term treatment with antidepressants in primary care. Are sub-therapeutic doses still being used? Psychiatr Bull 22:15–19

    Google Scholar 

  3. APA (2000) Diagnostic and Statistical Manual of Mental disorders. DSM-IV-TR. 4th edn. In: Association AP (ed) Text revision. Washington, DC

  4. Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR (2000) Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 62:633–638

    Article  PubMed  CAS  Google Scholar 

  5. Bartholomew JB, Morrison D, Ciccolo JT (2005) Effects of acute exercise on mood and well-being in patients with major depressive disorder. Med Sci Sports Exerc 37:2032–2037

    Article  PubMed  Google Scholar 

  6. Benedict R (1997) Brief Visuospatial Memory-Test-Revised. Psychological Assessment Resources Inc, Odessa, FL

    Google Scholar 

  7. Bentall RP, Slade PD (1985) Reliability of a scale measuring disposition towards hallucinations: a brief report. Personal Individ Differ 6:527–529

    Article  Google Scholar 

  8. Bohus M, Wolf M (2009) Interaktives Therapieprogramm für Borderline-Patienten. Therapeuten-Version, Schattauer

    Google Scholar 

  9. Brandt J, Benedict R (2001) Hopkins Verbal Learning Test-Revised. Psychological Assessment Resources Inc, Odessa, FL

    Google Scholar 

  10. Brehm W, Janke A, Sygusch R, Wagner P (2006) Gesund durch Gesundheitssport: Zielgruppenorientierte Konzeption, Durchführung und Evaluation von Gesundheitssportprogrammen. Juventa Verlag, Weinheim und München

    Google Scholar 

  11. Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand: Manual. Hogrefe Verlag, Göttingen

    Google Scholar 

  12. Bussfeld P, Czekalla J (2010) Therapieadhärenz bei Multipler Sklerose und Schizophrenie: Ein Vergleich von Therapieadhärenzraten und Verbesserungsansätzen in der Therapie zweier schubförmiger, chronischer Erkrankungen des zentralen Nervensystems. Fortschr Neurol Psychiat 78:139–146

    Article  PubMed  CAS  Google Scholar 

  13. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    Article  PubMed  CAS  Google Scholar 

  14. Cotman CW, Berchtold NC, Christie L-A (2007) Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci 30:464–472

    Article  PubMed  CAS  Google Scholar 

  15. Cowansage KK, LeDoux JE, Monfils MH (2010) Brain-derived neurotrophic factor: a dynamic gatekeeper of neural plasticity. Curr Mol Pharmacol 3:12–29

    Article  PubMed  CAS  Google Scholar 

  16. Deimel H, Hölter G (2011) Schizophrene Störungen. In: Bewegungstherapie bei psychischen Erkrankungen. Grundlagen und Anwendungen. deutscher Ärzte-Verlag GmbH, Köln, pp 211–287

  17. Douglas KM, Porter RJ (2009) Longitudinal assessment of neuropsychological function in major depression. Aust N Z J Psychiatry 43:1105–1117

    Article  PubMed  Google Scholar 

  18. Falkai P, Malchow B, Wobrock T, Gruber O, Schmitt A, Honer WG, Pajonk FG, Sun F, Cannon TD (2013) The effect of aerobic exercise on cortical architecture in patients with chronic schizophrenia: a randomized controlled MRI study. Eur Arch Psychiatry Clin Neurosci 263:469–473

    Article  PubMed  Google Scholar 

  19. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, Vos T, Whiteford HA (2013) Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 10:e1001547

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ferris LT, Williams JS, Shen CL (2007) The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Med Sci Sports Exerc 39:728–734

    Article  PubMed  CAS  Google Scholar 

  21. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359

    Article  PubMed  Google Scholar 

  22. Gold J, Carpenter C, Randolph C, Goldberg T, Weinberger D (1997) Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Arch Gen Psychiatry 54(2):159–165

    Article  PubMed  CAS  Google Scholar 

  23. Gold SM, Schulz KH, Hartmann S, Mladek M, Lang UE, Hellweg R, Reer R, Braumann KM, Heesen C (2003) Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls. J Neuroimmunol 138:99–105

    Article  PubMed  CAS  Google Scholar 

  24. Goldman-Rakic P (1994) Working memory dysfunction in schizophrenia. J Neuropsychiatry Clin Neurosci 6:348–357

    PubMed  CAS  Google Scholar 

  25. Görlitz G (2003) Körper und Gefühl in der Psychotherapie - Basisübungen. Pfeiffer bei Klett-Cotta, Stuttgart

    Google Scholar 

  26. Hahlweg K (2009) Schizophrenie. In: Schneider JMS (ed) Störungen im Erwachsenenalter - Spezielle Indikationen - Glossar (Lehrbuch der Verhaltenstherapie, Bd. 2, 3. Aufl., S. 407–434). Springer, Berlin

  27. Hautzinger M (2008) Psychotherapy of depression. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 51:422–429

    Article  PubMed  CAS  Google Scholar 

  28. Hautzinger M, Keller F, Kühner C (2006) Das Beck Depressionsinventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Harcourt Test Services, Frankfurt a. M

    Google Scholar 

  29. Heidenberger B (2013) zeitblueten.com. In:Burkhard Heidenberger, Wien

  30. Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445

    Article  PubMed  CAS  Google Scholar 

  31. Hoffman BM, Blumenthal JA, Babyak MA, Smith PJ, Rogers SD, Doraiswamy PM, Sherwood A (2008) Exercise fails to improve neurocognition in depressed middle-aged and older adults. Med Sci Sports Exerc 40:1344–1352

    Article  PubMed  PubMed Central  Google Scholar 

  32. Holley J, Crone D, Tyson P, Lovell G (2010) The effects of physical activity on psychological well-being for those with schizophrenia: a systematic review. Br J Clin Psychol 50:84–105

    Article  Google Scholar 

  33. Iosifescu DV (2012) The relation between mood, cognition and psychosocial functioning in psychiatric disorders. Eur Neuropsychopharmacol 22(Suppl 3):S499–S504

    Article  PubMed  CAS  Google Scholar 

  34. Jerstad SJ, Boutelle KN, Ness KK, Stice E (2010) Prospective reciprocal relations between physical activity and depression in female adolescents. J Consult Clin Psychol 78:268–272

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kay SR, Fiszbein A, Opler LA (1987) The Positive and Negative Symptom Scale (PANSS) for Schizophrenia. Schizophr Bull 13:261–276

    Article  PubMed  CAS  Google Scholar 

  36. Keefe R (1999) Brief assessment of cognition in schizophrenia. Duke University Medical Center, Durham, NC

    Google Scholar 

  37. Knapen J, Sommerijns E, Vancampfort D, Sienaert P, Pieters G, Haake P, Probst M, Peuskens J (2009) State anxiety and subjective well-being responses to acute bouts of aerobic exercise in patients with depressive and anxiety disorders. Br J Sports Med 43:756–759

    Article  PubMed  CAS  Google Scholar 

  38. Knöchel C, Oertel-Knochel V, O’Dwyer L, Prvulovic D, Alves G, Kollmann B, Hampel H (2012) Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol 96:46–68

    Article  PubMed  Google Scholar 

  39. Kubesch S, Bretschneider V, Freudenmann R, Weidenhammer N, Lehmann M, Spitzer M, Gron G (2003) Aerobic endurance exercise improves executive functions in depressed patients. J Clin Psychiatry 64:1005–1012

    Article  PubMed  Google Scholar 

  40. Lampinen P, Heikkinen E (2003) Reduced mobility and physical activity as predictors of depressive symptoms among community-dwelling older adults: an eight-year follow-up study. Aging Clin Exp Res 15:205–211

    Article  PubMed  Google Scholar 

  41. Laux L, Glanzmann P, Schaffner P, Spielberger C (1981) State-Trait-Angstinventar (STAI). Theoretische Grundlagen und Handanweisungen. Beltz Test GmbH, Weinheim

    Google Scholar 

  42. Lipsky RH, Marini AM (2007) Brain-derived neurotrophic factor in neuronal survival and behavior-related plasticity. Ann N Y Acad Sci 1122:130–143

    Article  PubMed  CAS  Google Scholar 

  43. Malchow B, Reich-Erkelenz D, Oertel-Knöchel V, Keller K, Hasan A, Schmitt A, Scheewe TW, Cahn W, Kahn RS, Falkai P (2013) The effects of physical exercise in schizophrenia and affective disorders. Eur Arch Psychiatry Clin Neurosci 263(6):451–467. doi:10.1007/s00406-013-0423-2

  44. Marker KR (1987–2012) COGPACK. The Cognitive Training Package Manual. Marker. Softw., Heidelberg

  45. Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA (2009) Exercise for depression. Cochrane Database Syst Rev (3):CD004366. doi:10.1002/14651858.CD004366.pub4

  46. Mogami T, Ikezawa S, Kaneko K, Pu S, Nakagome K (2011) Outcome studies of cognitive remediation for schizophrenia. Nihon Shinkei Seishin Yakurigaku Zasshi 31:245–249

    PubMed  Google Scholar 

  47. Moltini R (2002) Differential effects of acute and chronic exercise on plasticity-related genes in the rat hippocampus revealed by microarray. Eur J Neurosci 16:1107–1116

    Article  Google Scholar 

  48. Morrison AP, Wells A, Nothard S (2002) Cognitive and emotional predictors of predisposition to hallucinations in non-patients. Br J Clin Psychol 41(3):259–270

    Article  PubMed  Google Scholar 

  49. Morrison AP, Wells A, Nothard S (2002) Cognitive and emotional predictors of predisposition to hallucinations in non-patients. Br J Clin Psychol 41:259–270

    Article  PubMed  Google Scholar 

  50. National Collaborating Centre for Mental Health U (2009) Psychological therapy and psychosocial interventions in the treatment and management of schizophrenia Leicester (UK)

  51. Neeper SA, Gomez-Pinilla F, Choi J, Cotman C (1995) Exercise and brain neurotrophins. Nature 373:109

    Article  PubMed  CAS  Google Scholar 

  52. Neeper SA, Gomez-Pinilla F, Choi J, Cotman CW (1996) Physical activity increases mRNA for brain-derived neurotrophic factor and nerve growth factor in rat brain. Brain Res 726:49–56

    Article  PubMed  CAS  Google Scholar 

  53. Nuechterlein K, Green M (2006) MCCB–MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery. MATRICS Assessment Inc, Los Angeles

    Google Scholar 

  54. Pajonk F, Wobrock T, Gruber O, Scherk H, Berner D, Kaizl I (2010) Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen Psychiatry 67:133–143

    Article  PubMed  Google Scholar 

  55. Pelham TW, Campagna PD (1991) Benefits of exercise in psychiatric rehabilitation of persons with schizophrenia. Can J Rehabil 4:159–168

    Google Scholar 

  56. Reddemann L (2003) Imagination als heilsame Kraft - zur Behandlung von Traumafolgen mit ressourcenorientierten Verfahren. Pfeiffer bei Klett-Cotta, Stuttgart

    Google Scholar 

  57. Rock PL, Roiser JP, Riedel WJ, Blackwell AD (2013) Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 29:1–12

    Google Scholar 

  58. Rojas Vega S, Struder HK, Vera Wahrmann B, Schmidt A, Bloch W, Hollmann W (2006) Acute BDNF and cortisol response to low intensity exercise and following ramp incremental exercise to exhaustion in humans. Brain Res 1121:59–65

    Article  PubMed  CAS  Google Scholar 

  59. Rossler W, Salize HJ, van Os J, Riecher-Rossler A (2005) Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 15:399–409

    Article  PubMed  Google Scholar 

  60. Smits JA, Berry AC, Rosenfield D, Powers MB, Behar E, Otto MW (2008) Reducing anxiety sensitivity with exercise. Depress Anxiety 25:689–699

    Article  PubMed  Google Scholar 

  61. Stengel F, Ladner-Merz S (2009) Merken, Denken, Erinnern 1: Kognitives Training nach der Stengel-Methode: Trainerhandbuch mit CD. Memo Verlag, Stuttgart

    Google Scholar 

  62. Twamley EW, Jeste DV, Bellack AS (2003) A review of cognitive training in schizophrenia. Schizophr Bull 29:359–382

    Article  PubMed  Google Scholar 

  63. Van Praag H (2008) Neurogenesis and exercise: past and future directions. Neuromolecular Med 10:128–140

    Article  PubMed  Google Scholar 

  64. Vancampfort D, Knapen J, Probst M, Van Winkel R, Peuskens J, Maurissen K, Demunter H, De Hert M (2010) The therapeutic value of physical exercise for people with schizophrenia. Tijdschr Psychiatr 52:565–574

    PubMed  CAS  Google Scholar 

  65. Vasques PE, Moraes H, Silveira H, Deslandes AC, Laks J (2011) Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks. Clinics (Sao Paulo) 66:1553–1557

    Article  Google Scholar 

  66. Vohringer PA, Barroilhet SA, Amerio A, Reale ML, Alvear K, Vergne D, Ghaemi SN (2013) Cognitive impairment in bipolar disorder and schizophrenia: a systematic review. Front Psychiatry 4:87

    Article  PubMed  PubMed Central  Google Scholar 

  67. Voss MW, Vivar C, Kramer AF, van Praag H (2013) Bridging animal and human models of exercise-induced brain plasticity. Trends Cogn Sci 17:525–544

    Article  PubMed  Google Scholar 

  68. Wechsler DX (1997) Wechsler Memory Scale, 3rd edn. The Psychological Corporation, San Antonio, TX

    Google Scholar 

  69. Whiteman A, Young DE, He X, Chen TC, Wagenaar RC, Stern C, Schon K (2013) Interaction between serum BDNF and aerobic fitness predicts recognition memory in healthy young adults. Behav Brain Res 259:302–312

    Google Scholar 

  70. Wittchen H, Zhao S, Abelson JM, Abelson JL, Kessler RU (1996) Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders. Psychol Med 26:1169–1177

    Article  PubMed  CAS  Google Scholar 

  71. Woods S (2003) Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 64:663–667

    Article  PubMed  CAS  Google Scholar 

  72. Wykes T, Reeder C, Landau S, Everitt B, Knapp M, Patel A, Romeo R (2007) Cognitive remediation therapy in schizophrenia—randomised controlled trial. Br J Psychiatry 190:421–427

    Article  PubMed  Google Scholar 

  73. Zwick S, Laux G, Brunnauer A (2010) Auswirkungen eines kontrollierten Ausdauertrainings auf die kognitive Leistungsfähigkeit schizophrener Patienten. Psychiatrische Forschung Supplement 1:5–8

    Google Scholar 

Download references

Acknowledgments

We thank Andreas Bernardi for his help using the exercise equipment. We thank Lubomir Vladikov, Sonja von Usslar, Hafize Taskale, Florian Grüter and Susanne Böhm for their contribution to the exercise and cognitive trainings sessions. We thank Bernhard Heidenberger for his permission to use the relaxation exercises in our intervention group. We also thank the ‘Freunde der Universität,’ Goethe-University, Frankfurt/Main, Germany, and the ‘Nachwuchsförderer’ program of the Goethe-University, Frankfurt/Main, Germany, for the support and the help with the equipment.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany

    Viola Oertel-Knöchel, Pia Mehler, Kristina Steinbrecher, Karin Ademmer & David Prvulovic

  2. Institute of Sport Science, Goethe-University, Frankfurt am Main, Germany

    Christian Thiel & Winfried Banzer

  3. Department of Psychiatry and Psychotherapy, LMU Munich, Nußbaumstrasse 7, 80336, Muenchen, Germany

    Berend Malchow & Andrea Schmitt

  4. Institute of General Practice, Goethe-University, Frankfurt am Main, Germany

    Valentina Tesky

  5. Department of Medicine, University of Erlangen, Erlangen, Germany

    Yurdagül Zopf

  6. Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Rua Dr. Ovidio Pires de Campos 785, São Paulo, SP, 05453-010, Brazil

    Andrea Schmitt

  7. Institute of Sport Science, Technical University Darmstadt, Darmstadt, Germany

    Frank Hänsel

Authors
  1. Viola Oertel-Knöchel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pia Mehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Thiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristina Steinbrecher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Berend Malchow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valentina Tesky
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karin Ademmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Prvulovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Winfried Banzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yurdagül Zopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andrea Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Frank Hänsel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Viola Oertel-Knöchel.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 178 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oertel-Knöchel, V., Mehler, P., Thiel, C. et al. Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 264, 589–604 (2014). https://doi.org/10.1007/s00406-014-0485-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-014-0485-9

Keywords

Search

Navigation