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Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Schizophrenia is a severe neuropsychiatric disease that is associated with neurobiological alterations in multiple brain regions and peripheral organs. Negative symptoms and cognitive deficits are present in about half of patients and are difficult to treat, leading to an unfavorable functional outcome. To investigate the impact of aerobic exercise on various neurobiological parameters, we conducted a narrative review. Add-on aerobic exercise was shown to be effective in improving negative and general symptoms, cognition, global functioning, and quality of life in schizophrenia patients. Based on findings in healthy individuals and animal models, this qualitative review gives an overview of different lines of evidence on how aerobic exercise impacts brain structure and function and molecular mechanisms in patients with schizophrenia and how its effects could be related to clinical and functional outcomes. Structural magnetic resonance imaging studies showed a volume increase in the hippocampus and cortical regions in schizophrenia patients and healthy controls after endurance training. However, results are inconsistent and individual risk factors may influence neuroplastic processes. Animal studies indicate that alterations in epigenetic mechanisms and synaptic plasticity are possible underlying mechanisms, but that differentiation of glial cells, angiogenesis, and possibly neurogenesis may also be involved. Clinical and animal studies also revealed effects of aerobic exercise on the hypothalamus–pituitary–adrenal axis, growth factors, and immune-related mechanisms. Some findings indicate effects on neurotransmitters and the endocannabinoid system. Further research is required to clarify how individual risk factors in schizophrenia patients mediate or moderate the neurobiological effects of exercise on brain and cognition. Altogether, aerobic exercise is a promising candidate in the search for pathophysiology-based add-on interventions in schizophrenia.

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Fig. 1

Legends: Dauwan et al. [6], Firth et al. [11], Firth et al. [9], Vancampfort et al. [3]

Fig. 2

Legends: Firth et al. [33], Weinstein et al. [35], Svatkova et al. [51], Brockett et al. [68], Voisin et al. [85], van Praag [26], Pereira et al. [77], Szuhany et al. [110], Meeusen and De Meirleir [144], Tantimonaco et al. [177], Stranahan et al. [183], Gomes da Silva et al. [200]

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Acknowledgements

This research was funded by the following grants from the German Research Foundation (DFG): Klinische Forschergruppe (KFO) 241, and PsyCourse to PF (FA241/16-1). Further funding was received from the German Federal Ministry of Education and Research (BMBF) through the research network on psychiatric diseases ESPRIT (grant number 01EE1407E) to PF, AH, and AS. The authors would like to thank Jacquie Klesing, BMedSci (Hons), Board-certified Editor in the Life Sciences (ELS), for editing assistance with the manuscript. Ms. Klesing received compensation for her work from the LMU Munich, Germany.

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  1. Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany

    Isabel Maurus, Alkomiet Hasan, Astrid Röh, Shun Takahashi, Boris Rauchmann, Daniel Keeser, Andrea Schmitt & Peter Falkai

  2. Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan

    Shun Takahashi

  3. Department of Radiology, University Hospital, LMU Munich, Munich, Germany

    Daniel Keeser

  4. Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany

    Berend Malchow

  5. Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil

    Andrea Schmitt

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  1. Isabel Maurus
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Maurus, I., Hasan, A., Röh, A. et al. Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 269, 499–515 (2019). https://doi.org/10.1007/s00406-019-01025-w

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