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October 2010

Exercise in Schizophrenia
Regular exercise can positively affect mental and physical health in people with schizophrenia.

Recognizing and Mitigating Delirium
Preventing delirium in hospitalized older patients saves lives and decreases dementia.

Lorcaserin: A New Drug for Weight Loss?
Lorcaserin has a better safety and adverse event profile but no greater efficacy than currently available weight loss agents.

In Brief
Bupropion during Pregnancy May Increase Risk of ADHD in Offspring; Bipolar Disorder Screening Recommended for Patients with Fibromyalgia

Treating Bipolar II Depression
Only quetiapine (Seroquel) is established as a first-line treatment for bipolar II depression; lithium, selective serotonin reuptake inhibitors (SSRIs), lamotrigine (Lamictal), and pramipexole (Mirapex and others) are second-line options.

Exercise in Schizophrenia

October 2010

Physical exercise is believed to have strong health benefits. It improves cardiovascular function, muscle tone, and bone health, and can contribute to weight loss. Growing evidence suggests that, singly or combined with other treatments, exercise may help combat depression. What about schizophrenia?

Gorczynski and Faulkner searched the Cochrane Schizophrenia Group Trials Register to assess randomized controlled trials of physical activity or exercise for patients with schizophrenia or schizophrenia-like illnesses.1 They identified only three suitable studies, but all found that exercise improves physical health. In addition, exercise significantly improved negative symptoms of schizophrenia above that of usual treatment. Yoga appeared superior to other exercise for improving mental state and quality of life. (A recent study found that yoga was associated with a greater improvement in mood and greater decreases in anxiety than a metabolically matched walking exercise over 12 weeks.2)

The authors conclude that although there have been only a few trials involving not many subjects, evidence suggests that regular exercise is feasible and can have positive effects for mental as well as physical health in people with schizophrenia. They call for larger systematic studies.

As we noted recently in discussing "personalized care" in psychiatry (BTP 2010;33:35), treatments only work when they are applied—whether medications, psychotherapy, or exercise. To determine the best exercise regimen for a specific patient with schizophrenia, the clinician must allow the patient to participate in the selection process. Clinicians should work also with other team members and family members to tailor an optimal program for each patient. Even walking is preferable to a totally sedentary pattern. While awaiting results of the larger systematic trials called for by Gorczynski and Faulkner, it makes sense to recommend exercise for patients with chronic mental illness.

1Gorczynski P, Faulkner G: Exercise therapy for schizophrenia. Schizophr Bull 2010;36:665–666.

2Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, Perimutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE: Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study. J Alternative Complementary Med 2010; 16:1–8.