Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-25T22:12:51.490Z Has data issue: false hasContentIssue false
  • English
  • Français

A randomised controlled trial of adjunctive yoga and adjunctive physical exercise training for cognitive dysfunction in schizophrenia

Published online by Cambridge University Press:  12 August 2016

Triptish Bhatia ,
Sati Mazumdar ,
Joel Wood ,
Fanyin He ,
Raquel E. Gur ,
Ruben C. Gur ,
Vishwajit L. Nimgaonkar  and
Smita N. Deshpande
Triptish Bhatia*
Affiliation:
GRIP-NIH Project, Department of Psychiatry, PGIMER-Dr. R.M.L. Hospital, New Delhi, India
Sati Mazumdar
Affiliation:
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
Joel Wood
Affiliation:
WPIC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Fanyin He
Affiliation:
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
Raquel E. Gur
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Ruben C. Gur
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Vishwajit L. Nimgaonkar
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
Smita N. Deshpande
Affiliation:
Department of Psychiatry, PGIMER-Dr. R.M.L. Hospital, New Delhi, India
*
Triptish Bhatia, GRIP-NIH Project, Department of Psychiatry, Room 30, Park Street, PGIMER-Dr. R.M.L. Hospital, New Delhi, Delhi 110001, India. Tel: +91 11 23 404 363; Fax:+91 11 23 342 122; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Yoga and physical exercise have been used as adjunctive intervention for cognitive dysfunction in schizophrenia (SZ), but controlled comparisons are lacking.

Aims

A single-blind randomised controlled trial was designed to evaluate whether yoga training or physical exercise training enhance cognitive functions in SZ, based on a prior pilot study.

Methods

Consenting, clinically stable, adult outpatients with SZ (n=286) completed baseline assessments and were randomised to treatment as usual (TAU), supervised yoga training with TAU (YT) or supervised physical exercise training with TAU (PE). Based on the pilot study, the primary outcome measure was speed index for the cognitive domain of ‘attention’ in the Penn computerised neurocognitive battery. Using mixed models and contrasts, cognitive functions at baseline, 21 days (end of training), 3 and 6 months post-training were evaluated with intention-to-treat paradigm.

Results

Speed index of attention domain in the YT group showed greater improvement than PE at 6 months follow-up (p<0.036, effect size 0.51). In the PE group, ‘accuracy index of attention domain showed greater improvement than TAU alone at 6-month follow-up (p<0.025, effect size 0.61). For several other cognitive domains, significant improvements were observed with YT or PE compared with TAU alone (p<0.05, effect sizes 0.30–1.97).

Conclusions

Both YT and PE improved attention and additional cognitive domains well past the training period, supporting our prior reported beneficial effect of YT on speed index of attention domain. As adjuncts, YT or PE can benefit individuals with SZ.

Keywords

cognitionphysical exerciseRCTschizophreniayoga
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 29 , Issue 2 , April 2017 , pp. 102 - 114
Check for updates
Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Green, MF, Harvey, PD. Cognition in schizophrenia: past, present, and future. Schizophr Res Cogn 2014;1:e1–e9.Google Scholar
2. Meier, MH, Caspi, A, Reichenberg, A et al. Neuropsychological decline in schizophrenia from the premorbid to the postonset period: evidence from a population-representative longitudinal study. Am J Psychiatry 2014;171:91–101.Google Scholar
3. Abouzaid, S, Jutkowitz, E, Foley, KA, Pizzi, LT, Kim, E, Bates, J. Economic impact of prior authorization policies for atypical antipsychotics in the treatment of schizophrenia. Popul Health Manag 2010;13:247–254.CrossRefGoogle ScholarPubMed
4. Willis, M, Svensson, M, Lothgren, M, Eriksson, B, Berntsson, A, Persson, U. The impact on schizophrenia-related hospital utilization and costs of switching to long-acting risperidone injections in Sweden. Eur J Health Econ 2010;11:585–594.Google Scholar
5. Millier, A, Schmidt, U, Angermeyer, MC et al. Humanistic burden in schizophrenia: a literature review. J Psychiatr Res 2014;54:85–93.Google Scholar
6. Kopelowicz, A, Liberman, RP. Integrating treatment with rehabilitation for persons with major mental illnesses. Psychiatr Serv 2003;54:1491–1498.CrossRefGoogle ScholarPubMed
7. Dunlop, J, Brandon, NJ. Schizophrenia drug discovery and development in an evolving era: are new drug targets fulfilling expectations? J Psychopharmacol 2015;29:230–238.CrossRefGoogle Scholar
8. Wykes, T, Huddy, V, Cellard, C, Mcgurk, SR, Czobor, P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry 2011;168:472–485.CrossRefGoogle ScholarPubMed
9. Garfinkel, MS, Schumacher, HR Jr, Husain, A, Levy, M, Reshetar, RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 1994;21:2341–2343.Google ScholarPubMed
10. Nangia, D, Malhotra, R. Yoga, cognition and mental health. J Indian Acad Appl Psychol 2012;38:262–269.Google Scholar
11. Gothe, N, Pontifex, MB, Hillman, C, Mcauley, E. The acute effects of yoga on executive function. J Phys Act Health 2013;10:488–495.Google Scholar
12. Tran, MD, Holly, RG, Lashbrook, J, Amsterdam, EA. Effects of hatha yoga practice on the health-related aspects of physical fitness. Prev Cardiol 2001;4:165–170.Google Scholar
13. Berger, BG, Owen, DR. Mood alteration with yoga and swimming: aerobic exercise may not be necessary. Percept Mot Skills 1992;75:1331–1343.CrossRefGoogle Scholar
14. Pilkington, K, Kirkwood, G, Rampes, H, Richardson, J. Yoga for depression: the research evidence. J Affect Disord 2005;89:13–24.CrossRefGoogle ScholarPubMed
15. Bhatia, T, Agarwal, A, Shah, G et al. Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomized trial. Acta neuropsychiatr 2012;24:91–100.Google Scholar
16. Vancampfort, D, Vansteelandt, K, Scheewe, T et al. Yoga in schizophrenia: a systematic review of randomised controlled trials. Acta Psychiatr Scand 2012;126:12–20.CrossRefGoogle ScholarPubMed
17. Balasubramaniam, M, Telles, S, Doraiswamy, PM. Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front Psychiatry 2012;3:117.Google ScholarPubMed
18. Cramer, H, Lauche, R, Klose, P, Langhorst, J, Dobos, G. Yoga for schizophrenia: a systematic review and meta-analysis. BMC Psychiatry 2013;13:32.Google Scholar
19. Jayaram, N, Varambally, S, Behere, RV et al. Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia. Indian J Psychiatry 2013;55(Suppl. 3):S409–S413.Google ScholarPubMed
20. Broderick, J, Knowles, A, Chadwick, J, Vancampfort, D. Yoga versus standard care for schizophrenia (review). The Cochrane Collaboration, JohnWiley & Sons Ltd. Cochrane Database of Systematic Reviews 2015, article no.: CD010554. doi:10.1002/14651858.CD010554.pub2.Google Scholar
21. Dishman, RK, Berthoud, HR, Booth, FW et al. Neurobiology of exercise. Obesity (Silver Spring) 2006;14:345–356.CrossRefGoogle ScholarPubMed
22. Stein, DJ, Collins, M, Daniels, W, Noakes, TD, Zigmond, M. Mind and muscle: the cognitive-affective neuroscience of exercise. CNS Spectr 2007;12:19–22.CrossRefGoogle ScholarPubMed
23. Vaynman, S, Gomez-Pinilla, F. Revenge of the ‘sit’: how lifestyle impacts neuronal and cognitive health through molecular systems that interface energy metabolism with neuronal plasticity. J Neurosci Res 2006;84:699–715.CrossRefGoogle ScholarPubMed
24. Baker, LD, Frank, LL, Foster-Schubert, K et al. Aerobic exercise improves cognition for older adults with glucose intolerance, a risk factor for Alzheimer’s disease. J Alzheimers Dis 2010;22:569–579.Google Scholar
25. Malchow, B, Reich-Erkelenz, D, Oertel-Knochel, V et al. The effects of physical exercise in schizophrenia and affective disorders. Eur Arch Psychiatry Clin Neurosci 2013;263:451–467.CrossRefGoogle ScholarPubMed
26. Knochel, C, Oertel-Knochel, V, O’Dwyer, L et al. Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol 2012;96:46–68.Google Scholar
27. Ten Have, M, De Graaf, R, Monshouwer, K. Physical exercise in adults and mental health status findings from the Netherlands mental health survey and incidence study (NEMESIS). J Psychosom Res 2011;71:342–348.Google Scholar
28. Gorczynski, P, Faulkner, G. Exercise therapy for schizophrenia. Schizophr Bull 2010;36:665–666.Google Scholar
29. Kimhy, D, Vakhrusheva, J, Bartels, MN et al. The impact of aerobic exercise on brain-derived neurotrophic factor and neurocognition in individuals with schizophrenia: a single-blind, randomized clinical trial. Schizophr Bull 2015;41:859–868.Google Scholar
30. Bhatia, T, Mazumdar, S, Mishra, NN et al. Protocol to evaluate the impact of yoga supplementation on cognitive function in schizophrenia: a randomised controlled trial. Acta Neuropsychiatr 2014;26:280–290.Google Scholar
31. Gur, RC, Ragland, JD, Moberg, PJ et al. Computerized neurocognitive scanning: II. The profile of schizophrenia. Neuropsychopharmacology 2001;25:777–788.Google Scholar
32. GUR, RC, Richard, J, Hughett, P et al. A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. J Neurosci Methods 2010;187:254–262.Google Scholar
33. Thomas, P, Bhatia, T, Gauba, D et al. Exposure to herpes simplex virus, type 1 and reduced cognitive function. J Psychiatr Res 2013;47:1680–1685.Google Scholar
34. Bhatia, T, Garg, K, Pogue-Geile, M, Nimgaonkar, VL, Deshpande, SN. Executive functions and cognitive deficits in schizophrenia: comparisons between probands, parents and controls in India. J Postgrad Med 2009;55:3–7.Google Scholar
35. Duraiswamy, G, Thirthalli, J, Nagendra, HR, Gangadhar, BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia – a randomized controlled trial. Acta Psychiatr Scand 2007;116:226–232.CrossRefGoogle ScholarPubMed
36. The SAS system for Windows. Release 9.2. [program]. 9.2 version. Cary, NC: SAS Institute, 2011.Google Scholar
37. Blakesley, RE, Mazumdar, S, Dew, MA et al. Comparisons of methods for multiple hypothesis testing in neuropsychological research. Neuropsychology 2009;23:255–264.CrossRefGoogle ScholarPubMed
38. Forbes, D, Thiessen, EJ, Blake, CM, Forbes, SC, Forbes, S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2013;12:CD006489.Google Scholar
39. Cotman, CW, Berchtold, NC. Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci 2002;25:295–301.Google Scholar
40. Draganski, B, Gaser, C, Busch, V, Schuierer, G, Bogdahn, U, May, A. Neuroplasticity: changes in grey matter induced by training. Nature 2004;427:311–312.CrossRefGoogle ScholarPubMed
41. Pereira, MA, Rifas-Shiman, SL, Kleinman, KP, Rich-Edwards, JW, Peterson, KE, Gillman, MW. Predictors of change in physical activity during and after pregnancy: project viva. Am J Prev Med 2007;32:312–319.CrossRefGoogle ScholarPubMed
42. Massin, MM. The role of exercise testing in pediatric cardiology. Arch Cardiovasc Dis 2014;107:319–327.Google Scholar
43. Strassnig, MT, Signorile, JF, Potiaumpai, M et al. High velocity circuit resistance training improves cognition, psychiatric symptoms and neuromuscular performance in overweight outpatients with severe mental illness. Psychiatry Res 2015;229:295–301.CrossRefGoogle ScholarPubMed
44. Lin, J, Chan, SKW, Lee, EHM et al. Aerobic exercise and yoga improve neurocognitive function in women with early psychosis. NPJ Schizophr 2015;1:15047.Google Scholar
45. Arango, C, Amador, X. Lessons learned about poor insight. Schizophr Bull 2011;37:27–28.Google Scholar
46. Arango, C, Bartko, JJ, Gold, JM, Buchanan, RW. Prediction of neuropsychological performance by neurological signs in schizophrenia. Am J Psychiatry 1999;156:1349–1357.Google Scholar
47. Cowell, AJ, Pollio, DE, North, CS, Stewart, AM, Mccabe, MM, Anderson, DW. Deriving service costs for a clubhouse psychosocial rehabilitation program. Adm Policy Ment Health 2003;30:323–340.CrossRefGoogle ScholarPubMed
48. Rao, NP, Varambally, S, Gangadhar, BN. Yoga school of thought and psychiatry: therapeutic potential. Indian J Psychiatry 2013;55(Suppl. 2):S145–S149.CrossRefGoogle ScholarPubMed
49. Vancampfort, D, De Hert, M, Knapen, J et al. State anxiety, psychological stress and positive well-being responses to yoga and aerobic exercise in people with schizophrenia: a pilot study. Disabil Rehabil 2011;33:684–689.Google Scholar
50. Yaguez, L, Shaw, KN, Morris, R, Matthews, D. The effects on cognitive functions of a movement-based intervention in patients with Alzheimer’s type dementia: a pilot study. Int J Geriatr Psychiatry 2011;26:173–181.CrossRefGoogle ScholarPubMed
51. Malchow, B, Schmitt, A, Falkai, P. Physical activity in mental disorders. MMW Fortschr Med 2014;156:41–43.Google Scholar
52. Duman, RS. Neurotrophic factors and regulation of mood: role of exercise, diet and metabolism. Neurobiol Aging 2005;26(Suppl. 1):88–93.Google Scholar
53. Van Praag, H, Shubert, T, Zhao, C, Gage, FH. Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci 2005;25:8680–8685.CrossRefGoogle ScholarPubMed
Supplementary material: File

Bhatia supplementary material

Tables S1-S5

Download Bhatia supplementary material(File)
File 63.7 KB