Schizophrenia and Physical Exercise
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      Schizophrenia is a severe mental illness, of psychosis being the most prevalent in society,
      affecting 1% of the population. The treatment of schizophrenia is basically done with
      antipsychotic drugs, although other non-pharmacological interventions, such as exercise, a
      form of treatment seems to be considered. Among the most recommended exercise for the general
      population, the investigators highlight the aerobic and resistance exercises. However, few
      studies have reported the positive effect of aerobic exercise in the pathogenesis of
      schizophrenia. In relation to resistance exercise, it is unknown if the effect in patients
      with the disease, especially when one considers the junction of the two types of exercises in
      the same training session (called concurrent training). However, it is known, through
      clinical studies and animal models, that exercise modifies the brain improves
      neuroplasticity, the mental condition of the individual frames and reverses
      neurodegeneration. Associated with improvement in schizophrenia, few clinical trials of
      aerobic exercise showed improvement in disease symptoms, reducing anxiety and depression, and
      clinical global improvement. The hypothesis is that the types of proposed training, aerobic
      training, resistance training and concurrent training can improve clinical symptoms of the
      disease, and improve the side effects caused by drugs. It is believed that the clinical
      changes are accompanied by increased serum IGF-1 by resistance training and aerobic training
      by BDNF.
    

Detailed description: 
      Schizophrenia is a serious mental disease characterized by a combination of positive and
      negative symptoms, and it is associated with social and occupational dysfunction. The
      positive symptoms reflect an excess or distortion of normal functions (delusions,
      hallucinations and disorganized behavior), whereas the negative symptoms are related to
      flattened affect, alogia, avolition and decreased cognitive function. One recent study
      reported that schizophrenia is associated with distortions of reality, changes in perceptions
      and thoughts, difficulties in social situations and problems with daily functions.

      Schizophrenia generally appears at the end of adolescence or at the beginning of adulthood
      and affects approximately 1% of the population. The disease has a deteriorating course and
      does not involve large neurological changes. Its etiology may be explained by interactions
      between factors associated with genetic susceptibility and adverse environmental factors.
      Recently, it has been hypothesized that alterations in neuroplasticity may be an important
      factor for the development of schizophrenia.

      IGF-1 is an important growth factor that induces neuroplasticity (neuronal survival, cell
      differentiation, cell proliferation, synaptic plasticity and neurogenesis). Schizophrenic
      patients have lower serum IGF-1 levels than healthy individuals. Because IGF-1 levels are
      lower in schizophrenic patients and this is associated with the etiology of the disease, it
      is important to investigate treatments that may increase serum IGF-1. Antipsychotic drugs
      such as olanzapine stimulate the phosphorylation of AKT, which is part of the main downstream
      pathway of IGF-1. It is possible to activate AKT through several intracellular signals and
      receptors, including activation of the insulin receptor (IR). However, activation of the
      IGF-1 receptor (IGF-1R) appears to be the main activator of AKT phosphorylation.

      In addition to antipsychotic medications, resistance exercises may be another way to increase
      IGF-1 concentrations. This type of physical exercise has been growing in popularity in
      society. In recent years, evidence has shown benefits from this exercise for different age
      groups in both healthy and sick individuals, and it has been indicated to augment bone
      mineral mass, strength and muscular mass; to prevent or treat sarcopenia; to decrease frailty
      and functional impairment; and to improve cognitive function and hypertension, among other
      benefits.

      Studies conducted with the young and the elderly who underwent resistance training have shown
      increased serum IGF-1 levels. However, studies showing the effects of resistance training on
      schizophrenia and serum IGF-1 levels have not been performed. Studying resistance training is
      important for several reasons. Importantly, it is a low-cost treatment that may be a possible
      therapeutic tool, not only to increase IGF-1 concentrations but also to decrease disease
      symptoms, especially negative symptoms, and the side effects of antipsychotic drugs
      (extrapyramidal effects, weight gain and tiredness), which may improve quality of life.
      Therefore, the aim of this study is to evaluate the effects of 20 weeks of resistance
      training on psychotic and depressive symptoms, quality of life and serum IGF-1 concentration.
    

Intervention name(s): Physical Exercise; Control
Intervention type(s): Other; Other
Intervention description(s): The patients in this group will given a progressive resistance training program twice per week (Tuesday and Thursday) for 20 weeks. The training program followed the American College of Sports Medicine guidelines on resistance training for adults. Training sessions will performed at the same time of day (between 1 pm and 5 pm). The chosen exercises focused on the large muscle groups that are important for the patients' daily routines. The exercises include the leg press, leg curl, vertical traction, chest press, arm extension, arm curl and abdominal crunch using equipment manufactured by Technogym®.
Every training session will preceded by 5 minutes of warm-up on a Life Fitness® motorized stepper at a constant velocity of 4 km/h. A 1 RM test will be to determine the load settings, as performed in previous studies. The load will readjusted throughout training according to the results of a 1 RM test after the 2nd month of training (the 8th week of training) for each exercise.; Patients in this group will to the CEPE twice per week (Tuesday and Thursday) for 20 weeks and performed the same training protocol as the RESEX group. However, the equipment load (weight on each apparatus) is kept at the minimum (below 5% of 1 Repetition maximum - RM) throughout the treatment, without modifying the protocol. Patients execute 2 sets of 15 repetitions with a 1-minute rest interval on all of the equipment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Physical exercise; IGF-1; Schizophrenia; neuroplasticity