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Exercise effects on cognitive functioning in young adults with first-episode psychosis: FitForLife

  • Mats Hallgren (a1), Maria Skott (a2), Örjan Ekblom (a3), Joseph Firth (a4) (a5), Adrian Schembri (a6) and Yvonne Forsell (a1)...

Exercise has mood-enhancing effects and can improve cognitive functioning, but the effects in first-episode psychosis (FEP) remain understudied. We examined the feasibility and cognitive effects of exercise in FEP.


Multi-center, open-label intervention study. Ninety-one outpatients with FEP (mean age = 30 years, 65% male) received usual care plus a 12-week supervised circuit-training program, consisting of high-volume resistance exercises, aerobic training, and stretching. Primary study outcome was cognitive functioning assessed by Cogstate Brief Battery (processing speed, attention, visual learning, working memory) and Trailmaking A and B tasks (visual attention and task shifting). Within-group changes in cognition were assessed using paired sample t tests with effect sizes (Hedges’ g) reported for significant values. Relationships between exercise frequency and cognitive improvement were assessed using analysis of covariance. Moderating effects of gender were explored with stratified analyses.


Participants exercised on average 13.5 (s.d. = 11.7) times. Forty-eight percent completed 12 or more sessions. Significant post-intervention improvements were seen for processing speed, visual learning, and visual attention; all with moderate effect sizes (g = 0.47–0.49, p < 0.05). Exercise participation was also associated with a positive non-significant trend for working memory (p < 0.07). Stratified analyses indicated a moderating effect of gender. Positive changes were seen among females only for processing speed, visual learning, working memory, and visual attention (g = 0.43–0.69). A significant bivariate correlation was found between total training frequency and improvements in visual attention among males (r = 0.40, p < 0.05).


Supported physical exercise is a feasible and safe adjunct treatment for FEP with potential cognitive benefits, especially among females.

Corresponding author
Author for correspondence: Mats Hallgren, E-mail:
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Ahlin, J, et al. (2015) Adults with mild to moderate depression exhibit more alcohol related problems compared to the general adult population: a cross sectional study. BMC Public Health 15, 542.
Benoit, A, et al. (2015) Cognitive deficits characterization using the Cogstate research battery in first-episode psychosis patients. Schizophrenia Bulletin 41, S39S40.
Bora, E and Murray, RM (2014) Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophrenia Bulletin 40, 744755.
Bowie, CR and Harvey, PD (2006) Administration and interpretation of the Trail Making Test. Nature Protocols 1, 22772281.
Bozikas, VP and Andreou, C (2011) Longitudinal studies of cognition in first episode psychosis: a systematic review of the literature. Australian & New Zealand Journal of Psychiatry 45, 93108.
Caspersen, CJ, Powell, KE and Christenson, GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports 100, 126131.
Cassilhas, RC, et al. (2012) Spatial memory is improved by aerobic and resistance exercise through divergent molecular mechanisms. Neuroscience 202, 309317.
CDC (2018) Physical Activity and Health: The Benefits of Physical Activity [Online]. Stockholm, Sweden: Center for Disease Control and Prevention (CDC). Available at (Accessed 22 February 2018).
Cogstate (2017) Cogstate Brief Battery, Cogstate Data: Guidelines for analysis [Online]. Melbourne, Australia: Cogstate. (Accessed 22 February 2018).
Cooney, GM, et al. (2013) Exercise for depression. The Cochrane Database of Systematic Reviews 9, CD004366.
Correll, CU, et al. (2017) Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 16, 163180.
Cotman, CW, Berchtold, NC and Christie, LA (2007) Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends in Neuroscience 30, 464472.
Cromer, JA, et al. (2015) Comparison of cognitive performance on the Cogstate brief battery when taken in-clinic, in-group, and unsupervised. Clinical Neuropsychologist 29, 542558.
Ellison-Wright, I, et al. (2008) The anatomy of first-episode and chronic schizophrenia: an anatomical likelihood estimation meta-analysis. American Journal of Psychiatry 165, 10151023.
Firth, J, et al. (2015) A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychological Medicine 45, 13431361.
Firth, J, et al. (2016 a) Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin 43, 546556.
Firth, J, et al. (2016 b) Long-term maintenance and effects of exercise in early psychosis. Early Intervention in Psychiatry Sep 1. doi: 10.1111/eip.12365.
Firth, J, et al. (2018) Effect of aerobic exercise on hippocampal volume in humans: a systematic review and meta-analysis. Neuroimage 166, 230238.
Forti, LN, et al. (2017) Effects of resistance training at different loads on inflammatory markers in young adults. European Journal of Applied Physiology 117, 511519.
Fusar-Poli, P, et al. (2013) Progressive brain changes in schizophrenia related to antipsychotic treatment? A meta-analysis of longitudinal MRI studies. Neuroscience & Biobehavioral Reviews 37, 16801691.
Garber, CE, et al. (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. Medicine & Science in Sports & Exercise 43, 13341359.
Girgis, RR, et al. (2017) A randomized, double-blind, placebo-controlled clinical trial of tocilizumab, an interleukin-6 receptor antibody, for residual symptoms in schizophrenia. Neuropsychopharmacology Nov 1. doi: 10.1038/npp.2017.258.
Green, MF, et al. (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.
Hallgren, M, Vancampfort, D and Stubbs, B (2016 a) Exercise is medicine for depression: even when the ‘pill’ is small. Neuropsychiatric Disease & Treatment 12, 27152721.
Hallgren, M, et al. (2016 b) Exercise and internet-based cognitive-behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up. British Journal of Psychiatry 209, 416422.
Hamer, M, Boutcher, YN and Boutcher, SH (2007) Fatness is related to blunted vascular stress responsivity, independent of cardiorespiratory fitness in normal and overweight men. International Journal of Psychophysiology 63, 251257.
Keefe, RSE, et al. (2013) Clinical trials of potential cognitive-enhancing drugs in schizophrenia: what have we learned so far? Schizophrenia Bulletin 39, 417435.
Keller-Varady, K, et al. (2017) A systematic review of trials investigating strength training in schizophrenia spectrum disorders. Schizophrenia Research 192, 6468.
Kimhy, D, et al. (2015) The impact of aerobic exercise on brain-derived neurotrophic factor and neurocognition in individuals with schizophrenia: a single-blind, randomized clinical trial. Schizophrenia Bulletin 41, 859868.
Kimhy, D, et al. (2016) Aerobic exercise for cognitive deficits in schizophrenia – the impact of frequency, duration, and fidelity with target training intensity. Schizophrenia Research 172, 213215.
Kolenic, M, et al. (2018) Obesity, dyslipidemia and brain age in first-episode psychosis. Journal of Psychiatric Research 99, 151158.
Lally, J, et al. (2017) Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. British Journal of Psychiatry 211, 350358.
Lim, YY, et al. (2013) Three-month stability of the CogState brief battery in healthy older adults, mild cognitive impairment, and Alzheimer's disease: results from the Australian Imaging, Biomarkers, and Lifestyle-Rate of Change Substudy (AIBL-ROCS). Archives of Clinical Neuropsychology 28, 320330.
Lin, J, et al. (2015) Aerobic exercise and yoga improve neurocognitive function in women with early psychosis. NPJ Schizophrenia 1, 15047.
Malla, AK, et al. (2002) Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32, 11091119.
Maruff, P, et al. (2009) Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Archives of Clinical Neuropsychology 24, 165178.
Mondelli, V, et al. (2011) Stress and inflammation reduce brain-derived neurotrophic factor expression in first-episode psychosis: a pathway to smaller hippocampal volume. Journal of Clinical Psychiatry 72, 16771684.
Nuechterlein, KH, et al. (2011) Neurocognitive predictors of work outcome in recent-onset schizophrenia. Schizophrenia Bulletin 37, 3340.
Nuechterlein, KH, et al. (2016) Enhancing cognitive training through aerobic exercise after a first schizophrenia episode: theoretical conception and pilot study. Schizophrenia Bulletin 42, S44S52.
Portugal, EMM, et al. (2013) Neuroscience of exercise: from neurobiology mechanisms to mental health. Neuropsychobiology 68, 114.
Rodriguez-Sanchez, JM, et al. (2013) Course of cognitive deficits in first episode of non-affective psychosis: a 3-year follow-up study. Schizophrenia Reseach 150, 121128.
Schuch, FB, et al. (2016) Neurobiological effects of exercise on major depressive disorder: a systematic review. Neuroscience & Biobehavioral Reviews 61, 111.
Silva, BA, et al. (2015) A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial. Revista Brasileira de Psiquiatria 37, 271279.
Stirling, J, et al. (2003) Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophrenia Research 65, 7586.
Tombaugh, TN (2004) Trail Making Test A and B: normative data stratified by age and education. Archives of Clinical Neuropsychology 19, 203214.
Vakhrusheva, J, et al. (2016) Aerobic exercise in people with schizophrenia: neural and neurocognitive benefits. Current Behavioral Neuroscience Reports 3, 165175.
Vancampfort, D, et al. (2015) Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry 14, 339347.
Vancampfort, D, et al. (2016) Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. General Hospital Psychiatry 39, 1523.
Vancampfort, D, et al. (2017) Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry 16, 308315.
Volkow, ND, et al. (2016) Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry 73, 292297.
Wykes, T, et al. (2011) A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472485.
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Psychological Medicine
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