ArticleLiterature Review

Mindful exercise versus non-mindful exercise for schizophrenia: A systematic review and meta-analysis of randomized controlled trials

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Objective To investigate whether the mindful exercise was more beneficial than non-mindful exercise for people with schizophrenia. Methods PubMed, Embase, Cochrane Library, and PsycINFO were searched from their onset to April 2017. Randomized controlled trials of schizophrenia were selected. Mindful exercises were yoga, tai chi or qigong. Non-mindful exercises included any type of purely physical exercise. Risk of bias was assessed using criteria in the Cochrane Handbook for Systematic Reviews of Interventions. Results Seven studies were identified. There were significant differences in favour of mindful exercise in psychiatric symptoms (total PANSS, 2 RCT, n = 101, MD -8.94, low-quality evidence) and “working memory” (1 RCT, n = 194, MD 0.39, low-quality). For outcomes of “attention” and social functioning, there was no clear difference. Four studies reported no adverse events. Conclusions Mindful exercise was more beneficial over non-mindful exercise on some outcomes of psychiatric symptoms and cognitive performance for schizophrenia.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... In recent years, a growing number of research studies have been focusing on the effect of a special type of exercise-mindful exercise-on anxiety. Mindful exercise refers to physical exercise with a mental emphasis at the same time [9]. It usually involves low to moderate physical movement with a mental focus on breathing and meditation at the same time [10]. ...
... The aim of this review is therefore to compare the relative effectiveness of two exercise interventions, namely mindful and non-mindful exercises, on reducing or treating anxiety as a psychological state in the non-clinical population. Existing reviews compared the differential effects of mindful and non-mindful interventions on depression [10] and schizophrenia [9]. Tsang, Chan and Cheung [10] did not find any difference between mindful and non-mindful exercises in reducing depressive symptoms. ...
... Tsang, Chan and Cheung [10] did not find any difference between mindful and non-mindful exercises in reducing depressive symptoms. On the other hand, Li, Shen, Wu, Tan, Sun, Keller, Jiang and Wu [9] found that mindful intervention, compared to non-mindful intervention, is effective in reducing psychiatric symptoms. However, the number of studies included in the review was limited. ...
Article
Full-text available
Background: In recent years, studies and reviews have reported the therapeutic benefits of both mindful and non-mindful exercises in reducing anxiety. However, there have not been any systematic reviews to compare their relative effectiveness for therapeutic application, especially among the non-clinical population. Thus, the aim of this review is to compare the effectiveness between mindful and non-mindful exercise on treating anxiety among non-clinical samples. Methods: Potential articles were retrieved from PubMed, Embase, Academic Search Premier, and PsycInfo. Randomized controlled trials, which involved both mindful and non-mindful exercises as intervention, and the use of anxiety outcome measures were included. Results: Twenty-four studies fulfilled the inclusion criteria and were included in our systematic review. In addition, 14 studies provided sufficient data to be included in the meta-analysis. For studies that reported significant group differences at post-assessment, results showed that mindful exercise was more beneficial in reducing anxiety than non-mindful exercise. The meta-analysis reported that yoga was more effective in reducing anxiety than non-mindful exercise. Conclusions: Compared to non-mindful exercise, yoga is shown to be more effective in alleviating anxiety symptoms. It is recommended that yoga could be used as a primary healthcare intervention to help the public reduce anxiety.
... Another meta-analysis found that mindful exercises such as yoga, tai-chi and qi-gong were more beneficial than non-mindful physical exercises in reducing psychiatric symptoms (Positive and Negative Syndrome Scale scores) and improving working memory in this population. However, the quality of evidence was low (Li 2018). Overall, yoga can be considered helpful as an adjunctive therapy in reducing negative symptoms and improving the quality of life in people with schizophrenia. ...
Article
Yoga was developed primarily as a tool for selfmastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.
... mental and cardiovascular health in some healthy and clinical populations, sometimes more than traditional (i.e., non-mindful) exercise modalities [6][7][8][9][10][11][12][13][14] . However, there is no consensus on the efficacy of two other mindful exercise modalities, meditative and mindful walking. ...
... The empirical evidence of YT on the general psychopathology of SSD seems to be more heterogeneous: A meta-analysis in 2018 reports that mindful exercises have more beneficial outcomes on psychiatric symptoms than non-mindful exercises, and Yoga specifically seemed to be a promising intervention for NS (31). Meta-analyses from the following year obtain similar results, concluding that mind-body therapies, including Yoga, can improve NS, yet effects are small (32) to moderate (33) and display high heterogeneity. ...
Article
Full-text available
Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity . Nevertheless, participants encountered challenges ; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation . YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.
... Conversely, no effect was found for exercise interventions on non-psychotic symptomatology, except for depression, where all subtypes of exercise but MBE had significant effect. In relation to this, three previous meta-analyses found significant benefit of small to medium effect size for AE and MBE on negative symptoms (Sabe et al., 2020(Sabe et al., , 2019Vogel et al., 2019), but in presence of substantial heterogeneity, which also applies to our data set Another meta-analysis found that MBE was more beneficial than other forms of physical exercise with regard to improvement of total PANSS score, but only two RCT were included and authors considered evidence as 'low quality' (Li et al., 2018). Improvements in cognition, psychopathology and physical performance may drive the encountered benefits of lifestyle interventions on global functioning and QoL. ...
Article
Patients with non-affective psychosis often lead unhealthy lifestyles. We performed a systematic review and meta-analysis on non-pharmacological RCTs for improvement of diet and physical activity in non-affective psychosis patients, including first-episode psychosis. A variety of outcomes was analysed, including metabolic, psychopathology, cognitive, functional and quality of life outcomes. Fifty-nine studies were included. An improvement in anthropometric measurements (BMI, weight, waist circumference) was observed post-intervention, persisting after follow-up. Post-intervention benefit was found also for psychotic symptoms severity (also persisting after follow-up), many cognitive domains and physical and global functioning and quality of life. Conversely, no effect was observed in relation to most blood metabolites, blood pressure and non-psychotic psychopathology and spontaneous physical activity. Improvement was generally larger for interventions including exercise, especially moderate/vigorous aerobic exercise, but follow-up maintenance was greater for psychotherapy interventions. Sensitivity analyses limited to chronic stages of psychosis and low risk of bias studies produced comparable results. Further studies are needed to design optimized interventions in this vulnerable population.
... It has been suggested that yoga, which is a kind of soft exercise with its components of breathing exercises and body poses, to promote awareness in thoughts, feelings and behaviors, in patients with schizophrenia and improve clinical insight in these areas (Budak & Yilmaz, 2019). There is insufficient evidence to show the superiority of mindful exercises over physical exercise in schizophrenia (Li et al., 2018). Music-sport therapy was also shown to increase insight in patients with schizophrenia (Hu et al., 2004). ...
To our knowledge, there are no studies on the effects of exercise in patients with severe schizophrenia-related disability or in nursing home settings. Again, the literature search on the influence of exercise on insight and resilience gives no results except mind-body exercises. The aim of this study was to investigate the effects of exercise on psychotic symptoms, depression, functionality, insight and resilience in patients with severe schizophrenia-related disability living in nursing home setting. Thirty-nine patients with schizophrenia were recruited. Exercise group with 20 patients who continued resistance exercise for 60 min, 2 days a week, for 3 months; and treatment as usual (TAU) group with 19 patients. All patients were administered Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia (CDSS), Schedule for Assessment of Insight (SAI), Functional Remission of General Schizophrenia Scale (FROGS), Resilience Scale for Adults (RSA) at baseline and 3 months after. There were no significant differences between the groups for baseline and third month scores. In both groups significant decrease in SANS scores, significant increase in scores of FROGS total and social functioning, daily life skills subscale and RSA perception of the self were observed. In exercise group, significant decrease in CDSS scores, and significant increase in SAI awareness of illness, FROGS health and treatment, occupational functioning scores were found. Exercise combined with TAU may be effective in increasing awareness of illness and alleviating depression in chronic schizophrenia.
... Thus, a systematic review is needed to synthesize the existing literature. While there were five reviews on this topic, they focused on either one type of MBE (25), just negative symptoms (26,27), qualitative synthesis (26) or MBEs-active control comparison (28), or included non-MBE studies (26), which make it difficult to provide an overview of MBE-induced effect on multiple symptoms of schizophrenia. Therefore, a comprehensive review with quantitative synthesis is necessary to systematically investigate the association between MBEs and a wide range of health outcomes in schizophrenia. ...
Article
Full-text available
Background: Mind-body exercises (MBEs) have been widely accepted as a complementary therapy for the patients with low exercise tolerance. Currently, the number of experimental studies investigating the effect of MBEs for improving symptoms in people with schizophrenia is increasing. However, results are inconsistent. Methods: We systematically reviewed and meta-analyzed the effects of mind-body exercises on schizophrenia. Seven electronic databases (Pubmed, Web of Science, PsycINFO, Embase, Cochrane Central Register of Controlled Trials [CENTRAL], CNKI and Wangfang) were screened through October 2019 and risk of bias of included studies were assessed in Review Manager 5.3. Results: Meta-analysis on 13 studies with 1159 patients showed moderately significant effects in favor of mind-body exercise intervention to improve positive symptoms (SMD = 0.31; 95% CI 0.01 to 0.60; p = 0.04), negative symptoms (SMD = 0.37; 95% CI 0.14 to 0.60; p = 0.002) and depression (SMD = 0.88; 95% CI 0.63 to 1.13; p<0.00001). Meta-regression analysis revealed that the improvement in positive symptoms was positively associated with the frequency of intervention (p = 0.04) while a marginally significant correlation was observed between the improved negative symptoms and duration of each session (p = 0.06). Conclusions: This meta-analysis supports the therapeutic effects of MBEs to aid in the treatment of schizophrenia. Further studies need to incorporate rigorous design and large sample size to identify the optimal type and dose of mind-body exercise to inform clinical practices on MBEs recommendations for the management of schizophrenia symptoms.
... Schizophrenia is a mental disorder characterized by hallucinations, delusions and poor emotional responses [80]. According to studies, schizophrenia pathophysiology suggests receptor dysregulation and alterations in the composition of thalamus membranes [81]. ...
Article
Liposomes, lipid-based vesicular systems, have attracted major interest as a means to improve drug delivery to various organs and tissues in the human body. Recent literature highlights the benefits of liposomes for use as drug delivery systems, including encapsulating of both hydrophobic and hydrophilic cargos, passive and active targeting, enhanced drug bioavailability and therapeutic effects, reduced systemic side effects, improved cargo penetration into the target tissue and triggered contents release. Pioneering work of liposomes researchers led to introduction of long-circulating, ligand-targeted and triggered release liposomes, as well as, liposomes containing nucleic acids and vesicles containing combination of cargos. Altogether, these findings have led to widespread application of liposomes in a plethora of areas from cancer to conditions such as cardiovascular, neurologic, respiratory, skin, autoimmune and eye disorders. There are numerous review articles on the application of liposomes in treatment of cancer, which seems the primary focus, whereas other diseases also benefit from liposome-mediated treatments. Therefore, this article provides an illustrated detailed overview of liposomal formulations, in vitro characterization and their applications in different disorders other than cancer. Challenges and future directions, which must be considered to obtain the most benefit from applications of liposomes in these disorders, are discussed.
Article
This research was conducted to determine the effect of an exercise program on functional remission and weight control in schizophrenia. This experimental study was conducted with pre-posttests and a control group at community mental health centers with 32 individuals with schizophrenia. The individuals participating in the program registered a more significant increase on the functional remission levels compared to the control group and a significant difference was found between the pretest/posttest BMI measures of the experimental group. The nurse-led exercise program is an effective plan that can be used in achieving functional remission.
Article
Full-text available
Background: Physical activity and self-compassion are closely related to individuals' mental health (eg, depression). However, most studies only examined their independent roles in mental health without considering the potential interaction between the two variables. The present study aimed to investigate the independent and joint associations between physical activity (PA) and self-compassion (SC) on depression symptoms and examine the additive interaction between PA and SC. Methods: A cross-sectional design was utilized in the present descriptive study. By recruiting participants via social media platforms, 1846 Chinese college students completed International Physical Activity Questionnaire Short Form, the Self-Compassion Scale-Short Form, the 9-item Patient Health Questionnaire, and items regarding socio-demographic information. Independent and joint roles of low-level PA (LPA) and low-level SC (LSC) on depression symptoms were examined by logistic regression models. Additive interaction between LPA and LSC on depression symptoms was examined by the following indices: relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). Socio-demographic variables were included in the models as covariates. Results: Both LPA (OR = 1.47 [1.16, 1.86]) and LSC (OR = 5.74 [3.89, 8.45]) were independently associated with higher probability of depression symptoms. Combining LPA and LSC led to an additive interaction and greatly increased the odds of depression symptoms (OR = 9.62 [5.38, 17.22]; RERI = 2.47 [0.19, 4.75], AP = 0.25 [0.05, 0.44], S = 1.38 [1.02, 1.87]). Conclusion: Both LPA and LSC were associated with an increased risk of depression symptoms. Moreover, combining LPA and LSC may develop an additive risk for depression symptoms. Future research and clinical intervention could integrate PA and SC to find a better way to resist depression symptoms.
Article
Objective To evaluate the effects of a single session of mindful exercise on anxiety and examine whether effects varied according to participant characteristics, mindful exercise exposure, or research design features. Methods Consistent with PRISMA guidelines for conduct and reporting, we identified randomized or non-randomized controlled trials (RCTs) that: (1) sampled healthy or unhealthy participants, (2) used a single session of yoga, Tai chi, or Qigong practice, and (3) assessed self-reported anxiety outcomes. Databases searched included Google Scholar, PubMed, PsycINFO, and Web of Science, from which 18 yoga, 5 Tai chi, and 4 Qigong articles were published before August 31, 2020. Studies involved 2341 participants (1904 in yoga studies, 232 in Tai chi studies, 205 in Qigong studies) were selected. Hedges d effect sizes were calculated. Random effect models and multilevel meta-analysis were used to estimate the pooled effects. I2 tests were applied to assess the heterogeneity. In yoga studies, moderating effects were tested by multilevel meta-regression analysis of putative moderators representing participant characteristics, features of mindful exercise exposure, and aspects of research design. Because of the limited number of Tai chi and Qigong studies, sensitivity analyses were conducted by omitting potential outlying effects and evaluating the overall pooled effect. Study quality was judged using the PEDro scale. Results A single session of yoga reduced anxiety by a heterogeneous (I2 = 82.7%) standardized mean effect size 0.32 (95% CI, 0.16 to 0.48, t = 4.108, p = 0.0002). In the multilevel univariate regression model, reductions were larger in participants who had previous yoga experience, or practiced Hatha yoga, or engaged in higher intensity yoga. Larger effects were also found when yoga was compared to no treatment or minimal treatment control than when yoga was compared to non-yoga exercise and when anxiety was measured 0–10 min immediately after yoga. In the multilevel multiple regression model, the effects remained larger for yoga history and yoga versus no treatment or minimal treatment control compared to yoga versus non-yoga exercise. Meta-regression analysis did not suggest other significant (p > 0.05) moderating effects on anxiety outcomes. The low heterogeneous (I2 = 10%) mean effect of a single session of Tai chi on anxiety was −0.06 (95% Cl, −0.38 to 0.24, t = −0.37, p = 0.68). The homogeneous (I2 = 0%) mean effect of a single session of Qigong on anxiety was 0.70 (95% CI, 0.22 to 1.18, t = 4.06, p = 0.02). Conclusion A single session of yoga may have small-to-moderate efficacy for the management of anxiety, but the limited number of studies for Tai chi and Qigong studies makes it premature to conclude their practical effectiveness. In addition, the overall quality of the included studies was relatively low. Cautions should be taken when applying a single session of mindful exercise to reduce anxiety in practice. Further high-quality randomized controlled trials are needed to mitigate methodological bias typically found in the retrieved studies.
Article
Introduction Schizophrenia is a chronic mental illness characterized by symptoms including hearing voices or seeing objects that do not exist, weak emotional reactions, and inadequate social relations. Schizophrenia is a long-term disease that is usually treated with anti-psychotic drugs. However, medication alone is insufficient for the treatment of patients with schizophrenia and alternative methods are needed. The aim of this study was to determine the effect that yoga has on the clinical insight and medication adherence in patients with schizophrenia. Methods This randomized controlled trial was conducted at the Community Mental Health Centre (CMHC). The study was conducted using a pretest / posttest and a control group. There were 50 patients with schizophrenia who participated, including 25 in the intervention group and 25 in the control group. The patients in the intervention group participated in group yoga practices every weekday for 8 weeks. No intervention was applied to the control group, and they received the CMHC’s routine care. The Descriptive Characteristics Form, Birchwood Insight Scale, and Morisky Medication Adherence Scale were used to collect data. Results The difference between the pretest and posttest mean scores for the insight and medication adherence scales was statistically significant in the intervention group (p < 0.01). There was also a statistically significant difference between the control group and intervention group for the pretest-posttest total mean scores on the insight and medication adherence scales (p < 0.01). Conclusion Yoga appeared to be effective for increasing medication adherence and clinical insight in patients with schizophrenia. It is recommended that yoga should be integrated within the rehabilitation period.
Article
Full-text available
Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types of exercise improved overall and depressive symptoms (all P⩽0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.
Article
Full-text available
Tai chi, also called taiji or tai chi chuan, is a form of mind-body exercise that originated from China. It combines Chinese martial arts and meditative movements that promote balance and healing of the mind and body, involving a series of slowly performed, dance-like postures that flow into one another. As it comprises mental concentration, physical balance, muscle relaxation, and relaxed breathing, tai chi shows great potential for becoming widely integrated into the prevention and rehabilitation of a number of medical and psychological conditions. A growing body of clinical research has begun to evaluate the efficacy of tai chi as a therapy for a variety of health issues. A systematic review and meta-analysis were carried out on randomized controlled trials (RCTs) and quasi-experimental (Q-E) trials that studied the effects of tai chi on psychological well-being. Drawn from English and Chinese databases, 37 RCTs and 5 Q-E studies published up to May 31, 2013 were included in the systematic review. The methodological quality of the RCTs was evaluated based on the following criteria: adequate sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential biases. Statistical analyses were performed using Review Manager version 5.0. The studies in this review demonstrated that tai chi interventions have beneficial effects for various populations on a range of psychological well-being measures, including depression, anxiety, general stress management, and exercise self-efficacy. Meta-analysis was performed on three RCTs that used depression as an outcome measure (ES = -5.97; 95 % CI -7.06 to -4.87), with I (2) = 0 %. In spite of the positive outcomes, the studies to date generally had significant methodological limitations. More RCTs with rigorous research design are needed to establish the efficacy of tai chi in improving psychological well-being and its potential to be used in interventions for populations with various clinical conditions.