Enhancing Cognitive Training Through Exercise Following a First Schizophrenia Episode

Study Overview
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Brief Summary
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This is a confirmatory randomized controlled trial of the efficacy of a novel intervention combining neuroplasticity-based cognitive training with aerobic exercise, compared to the same systematic cognitive training alone. Treatment occurs for 6 months after randomization, with a followup assessment at 12 months. The investigators hypothesize that combining neuroplasticity-based computerized cognitive training and neurotrophin-enhancing physical exercise will produce neurotrophin increases and cognitive and functional improvements, even relative to cognitive training alone. The investigators target the period shortly after a first episode of schizophrenia to maximize the generalization of cognitive improvement to functional outcome, before chronic disability is established.

Detailed Description
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The Cognitive Training and Exercise intervention consists of 24 weeks of systematic computerized cognitive training, 4 hours per week, plus aerobic exercise, 150 minutes per week. The Cognitive Training Intervention includes the same systematic cognitive training. The first 12 weeks involve neurocognitive training, using training exercises from Posit Science Brain HQ. The second 12 weeks involves social cognitive training, using the Posit Science SocialVille modules. Aerobic exercise occurs as two 45-minute sessions at the clinic and two 30-minute sessions at home weekly. Intensity of aerobic exercise is tailored to maintain an individualized target heart rate zone and is monitored by a heart rate recorder. A weekly one-hour Bridging Skills Group with other members of the treatment condition is designed to aid generalization of training to everyday life situations. The immediate target is brain-derived neurotrophic factor. The primary treatment outcomes are overall cognitive deficit level and global functioning level.

Official Title
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Enhancing Cognitive Training Through Exercise Following a First Schizophrenia Episode

Conditions
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Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder

Intervention / Treatment
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* Behavioral: Cognitive Training
* Behavioral: Aerobic Exercise
* Behavioral: Case management and supportive psychotherapy
* Behavioral: Individual Placement and Support


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a first episode of a psychotic illness that began within the past two years; a diagnosis by DSM-5 of schizophrenia, schizoaffective disorder, mainly depressed type, or schizophreniform disorder; sufficient acculturation and fluency in the English language to avoid invalidating research measures; and residence likely to be within commuting distance of the UCLA Aftercare Research Program. Exclusion Criteria: inability to participate in aerobic exercise; evidence of a known neurological disorder (e.g., epilepsy) or significant head injury; evidence of moderate or severe alcohol or substance use disorder within the six months prior to the first episode or evidence that substance abuse triggered the psychotic episode or makes the schizophrenia diagnosis ambiguous; or mental retardation, i.e. estimated premorbid IQ less than 70.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cognitive Training & Exercise<br>This arm involves a combination of systematic computerized cognitive training plus 150 minutes per week of aerobic exercise. All participants will also receive individual case management and supportive psychotherapy as well as Individual Placement and Support. | Behavioral: Cognitive Training<br>* 24 weeks of systematic computerized cognitive training, 4 hours per week. The first 12 weeks involves neurocognitive training, using auditory training exercises from Posit Science Brain HQ. The 2nd 12 weeks involves social cognitive training, using the Posit Science SocialVille modules. A weekly one-hour Bridging Skills Group is designed to aid generalization of training to everyday life situations.<br>* Other names: cognitive remediation;Behavioral: Aerobic Exercise<br>* Aerobic exercise occurs as two 45-minute sessions at the clinic and two 30-minute sessions at home weekly. Exercise involves an adaptation of interval training, including a variety of calisthenics that can be done without specialized equipment. Intensity of aerobic exercise is tailored to maintain an individualized target heart rate zone and is monitored by a heart rate recorder.<br>* Other names: physical exercise;Behavioral: Case management and supportive psychotherapy<br>* An individual therapist will provide weekly case management and therapy targeting the individual psychological problems and everyday functioning needs of the patient<br>Behavioral: Individual Placement and Support<br>* An job/school specialist will use the Individual Placement and Support model to help participants return to school or work and provide ongoing outreach support.<br>* Other names: supported education/employment;|
| Active Comparator: Cognitive Training<br>This arm includes the same systematic computerized cognitive training as the experimental condition, but without the additional aerobic exercise. All participants will also receive individual case management and supportive psychotherapy as well as and Individual Placement and Support. | Behavioral: Cognitive Training<br>* 24 weeks of systematic computerized cognitive training, 4 hours per week. The first 12 weeks involves neurocognitive training, using auditory training exercises from Posit Science Brain HQ. The 2nd 12 weeks involves social cognitive training, using the Posit Science SocialVille modules. A weekly one-hour Bridging Skills Group is designed to aid generalization of training to everyday life situations.<br>* Other names: cognitive remediation;Behavioral: Case management and supportive psychotherapy<br>* An individual therapist will provide weekly case management and therapy targeting the individual psychological problems and everyday functioning needs of the patient<br>Behavioral: Individual Placement and Support<br>* An job/school specialist will use the Individual Placement and Support model to help participants return to school or work and provide ongoing outreach support.<br>* Other names: supported education/employment;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) overall composite score | The Overall Composite score from the MCCB is a summary of cognitive performance across seven domains. | 6 months | 
| Global Functioning Scale: mean of Role and Social ratings | A 10-point rating scale to evaluate role and social functioning | 6 months | 
| Brain-derived neurotrophic factor (BDNF) | BDNF is a key neurochemical factor known to mediate the effects of exercise in the brain | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| YMCA fitness test | Cardiorespiratory fitness and muscular endurance measured by the YMCA fitness test | 6 months | 
| VO2 Max | A cardiovascular fitness measure derived from a treadmill test protocol | 6 months | 
| Role Functioning Scale | 7-point ratings of Work Productivity, Independent Living, Social Relationships, Family Relationships | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cognitive training, aerobic exercise, neurotrophic factors, randomized controlled trial, functional outcome