A Gateway to Understanding Psychosis: Studying Exercise in Mental Illness – Highlights from RCPsychIC 2019
This article is based on the talk by Prof Peter Falkai at the RCPsychIC 2019.
1. Around half of patients have somewhat favourable longitudinal outcomes in schizophrenia, bipolar disorder and major depression, leaving 50% with increasing residual symptoms. [Watt D et al., 1983], [Judd L et al., 2003]
2. Around 50% of patients have impaired outcomes from these relapsing disorders, and an underlying cause may be linked to cognitive dysfunction. We need to understand the pathophysiology of this cognitive dysfunction in major psychiatric disorders and psychosis and consider what can be done to improve outcomes.
3. It is known that aerobic training improves the global cognitive performance in schizophrenia with a clear effect in improving working memory, attention diligence and social cognition. [Firth J et al., 2017]
4. An investigation of hippocampal plasticity with exercise in schizophrenia revealed improved neurogenesis of the hippocampus, and improved synaptic plasticity and learning. [Pajonk F et al., 2010]
5. This exciting result led to a different 3-armed study, where patients were asked to do indoor cycling 3 times a week for 30 minutes over three months [Malchow B et al., 2015], [Malchow B et al., 2013]. There were two controls – one group of healthy individuals who also completed the cycling exercise, and one group of schizophrenia patients who played table soccer. In the second study, the endurance training was supplemented with computer-assisted remediation for both patients and controls.
4. The healthy controls showed an increase in hippocampal volume after three months, and the schizophrenia control group showed no change over time. The schizophrenia group conducting the endurance training showed a 5-10% increase in hippocampal volume, a reduction of negative symptoms, and an improvement in cognition.
5. In the mouse model, running Tcf4tg mice with social defeat show improved behaviour, hippocampal plasticity and increased binding of the SV2A PET-ligand. In humans, aerobic exercise improves functional outcome and hippocampal plasticity by addressing synaptic pathways.
6. Combining human and animal exercise studies can help us understand the molecular mechanisms underlying functional and structural changes in psychotic disorders that lead to disturbed functional outcome.