The Cogstate Blog

Expert perspectives on improving cognitive measures from clinical trials to clinical practice.

Structured Exercise Program Improves Cognitive Functioning for Patients with First-Episode Psychosis

June 6, 2018

While exercise is a proven partner in good brain health, its benefits are now being studied in more specific neurological disorders. Swedish and Australian researchers recently published a new study on the effects of an organized exercise program on a group of adults diagnosed with first-episode psychosis. Results showed a positive relationship between exercise and the cognitive functioning of these patients.

Affecting about 3% of the adult population, psychosis can interfere with the brain’s ability to understand reality through disrupted thoughts and perceptions. Cycling through episodes in a person’s life, the initial onset, known as first-episode psychosis (FEP) can be confusing for the patient and their family. Along with the unusual thought patterns, FEP can also cause decreased cognitive abilities, especially in attention, working memory, problem solving and speed of processing. Unfortunately, antipsychotic medications do not help these cognitive impairments.

In the new study published in Psychological Medicine, 91 outpatients from Stockholm-area clinics who were diagnosed with FEP were asked to participate in a 12-week supervised circuit-training program, consisting of high-volume resistance exercises, aerobic training, and stretching. In a program called Fit For Life, these young adults, with a mean age of 30, were asked to schedule their work out three times per week, with each session lasting an hour. They moved through 8 to 10 stations, rotating every 45 seconds with a short recovery between exercises. Shoulder presses, dumbbell curls, bench presses, leg presses, core stability, balancing movements and an aerobic activity rounded out the circuit.

Prior to the first exercise session, each patient tested their cognition using the Cogstate Brief Battery (CBB), which assessed four domains of cognition; processing speed using the ‘Detection Task’, attention using the ‘Identification Task’, visual learning using the ‘One Card Learning Task’, and working memory using the ‘One Back Task’.  The CBB takes approximately 12 min to complete.  In addition, two Trailmaking tests were also included to assess visual attention and task shifting.

While participation was less than optimal, the positive effect of exercise on cognitive functioning was clear. After comparing the pre and post-study cognitive assessments, the researchers found significant improvements in processing speed, visual learning and visual attention. A correlation was also found between total training frequency and visual attention among males; indicating that the more the male participants trained, the greater the benefit in visual attention. A positive but non-significant improvement was also found for working memory.

One difference between this study and previous studies of exercise and psychosis is the addition of strength training to the regimen. According to the study authors, one potential hypothesis is that the combination of aerobic and anaerobic activities may “stimulate neurogenesis through independent but complementary mechanisms.” While there was no control group in this study, the researchers feel that the large effect sizes would not have happened randomly.

Mats Hallgren, lead author and Associate Professor at the Karolinska Institute, Department of Public Health Sciences, commented, “Cognitive impairment is a core feature of psychotic illness, which adversely affects socio-occupational functioning and life quality. Of importance, these impairments do not respond well to anti-psychotic medication, so adjunct treatment strategies are needed. This is one of the first studies to demonstrate that regular exercise training can lead to measurable improvements in key areas of cognitive function in young adults with first episode psychosis. Statistically significant improvements were observed on measures of processing speed, visual learning, visual attention and working memory (females only). A next step will be to explore the underlying neurobiological mechanisms associated with these cognitive improvements.”