M44. COGNITIVE REMEDIATION AND PHYSICAL EXERCISE EFFECTS ON NEGATIVE SYMPTOMS AND FUNCTIONALITY IN PATIENTS WITH SCHIZOPHRENIA: A RANDOMIZED CONTROLLED TRIAL
Authors: Mane Anna , Cortizo Romina , Abellanas Adelina , Belmonte Elena , Toll Alba , Chamorro Jacobo , Treen Devi , Ayllon Lourdes , Polo Javier , Salvador Teresa , Moreno Daniel , Catala Ferran , Casado Patricia , Navas Dolors , Pujol Nuria 
Published: May 2020

Abstract

Background
Cognitive and negative symptoms are key determinants in schizophrenia functionality. Cognitive remediation (CR) has shown to improve cognition in patients with schizophrenia but the impact on functionality is still unsatisfactory. On the other hand, an improvement in negative symptoms has also been described with CR and some studies have shown physical exercise (PE) may also improve negative symptoms. The present study sets out to investigate the effects of CR+PE in overall negative symptoms, and more specifically, in the avolition and expression factor, as well as in functionality, in a sample of patients diagnosed with multi-episode schizophrenia. Furthermore, it sets out to investigate determinants of functionality at follow-up.

Methods
Randomized controlled trial with two groups: CR+PE and CR plus lifestyle promotion (LP) (control group) (www.clinicaltrials.gov NCT 02864576). Participants: Subjects fulfilling DSM-IV-TR criteria for schizophrenia or schizo-affective disorder diagnosis, aged between 25–60 years, with an illness duration &gt;o = 10 years, clinically stable and with low physical activity were included. Each randomly assigned intervention consists of 36 sessions carried out 3-times/week in groups of 4–6 participants of CR+PE or CR+LP. Analyses: Baseline sociodemographic and clinical characteristics were assessed at baseline in both groups. Repeated measures of multiple analysis of variance (MANOVA) was performed for negative symptoms (BNSS total scale and avolition and expression factors) and functionality (GAF score) with group (CR+PE vs CR+LP) as the between-subject factor and time (pre-treatment and post-treatment) as the within-group factor. The main effects of time, group, and time × group were examined. Multiple regression analysis (whole sample) with GAF at follow-up as the dependent variable and avolition, expression and PANSS-P subscale at follow-up, and gender and age as independent variables was also carried out.

Results
43 patients were included and randomized. 38 patients completed the study, 19 in each group. There were not statistically significant differences between both groups at baseline. There was a time x grup effect on GAF at follow-up (F=4.25 p= 0.047) and on the avolition factor (F=2.99 p= 0.09), with improvements in favour of the CR+ PE group. Furthermore, GAF at follow-up was only related with the avolition factor in the multiple regression analysis (B= -0.63, t -2.84, p=0.009 (CI -1.09-0.17)).

Discussion
CR+PE is associated with an improvement in negative symptoms, and more specifically, in the avolition factor, as well as in functionality. This specific improvement in the avolition factor is important, as functionality at follow-up is specifically associated with the avolition factor in our study, in accordance with previous studies.
This work is funded by the Instituto de Salud Carlos III-Subdirección General de Evaluación y Fomento de la Investigación, with the Research Project PI15/00453.