A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia

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Abstract

The chronic and prevalent natures of schizophrenia result in long-term institutionalization for the patients. Conventional treatment of anti-psychotic medication on management of psychotic symptoms often brings on severe side effects and reduces patients' well-being. Tai-chi is a mind–body exercise that underscores motor coordination and relaxation. This 3-arm randomized controlled trial investigated the psychophysiological benefits of Tai-chi on 153 chronic schizophrenia patients, who were recruited from a mental health rehab complex and randomized into Tai-chi, exercise, or waitlist control groups. Both intervention groups received 12 weeks of specific intervention plus standard medication received by the controls. All participants completed psychiatric interviews, self-report questionnaires, performance tasks, and salivary cortisol measures at baseline, 3-month, and 6-month follow-up on psychotic symptoms, motor coordination, memory, daily living function, and stress. Multigroup latent growth modeling was used to evaluate the intervention effects on the outcomes. Compared to controls, the Tai-chi group showed significant decreases in motor deficits and increases in backward digit span and mean cortisol, while the exercise group displayed significant decreases in motor deficits, negative and depression symptoms and increases in forward digit span, daily living function, and mean cortisol. The two interventions did not show significantly different therapeutic effects, except for fewer symptom manifestations in the exercise group. These results suggest psychophysiological benefits for Tai-chi on chronic schizophrenia patients in terms of motor coordination and memory. Though both Tai-chi and exercise groups tended to manifest fewer symptoms than the control group, the exercise group showed better symptoms management than the Tai-chi group.

Section snippets

Background

Schizophrenia affects approximately the lives of 24 million people worldwide. Despite a low incidence rate of 3 in 10,000 (Chen et al., 1998), the poor prognosis and chronicity render the illness rather prevalent (0.4–1%). Long-term care and illness management are crucial as psychotic symptoms persist throughout one's lifetime. While the symptoms can be managed with medication, the debilitating side-effects of treatment often considerably disrupt the physical and psychosocial well-being of the

Participants

The present study adopted a non-blind, 3-arm randomized controlled trial (RCT) with waitlist control design. Participants were patients with chronic schizophrenia residing in a mental health rehabilitation hostel in Hong Kong. The rehabilitation complex provided long-term care and halfway house services to the patients. The inclusion criteria of the study were fulfillment of DSM-IV TR criteria for schizophrenia, aged between 18 and 65 years, ability to understand and speak Cantonese, and no

Participant characteristics

Table 1 summarizes the profile of demographic characteristics of the participants by group. The mean age of the participants was 54.0 years (standard deviation (SD) = 8.4). The majority of the participants were male (53.0%), single (68.9%), had secondary education level (58.3%) and no prior experience on Tai-chi (83.4%), and performed daily exercise (59.6%). The average time since psychiatric diagnosis was 29.9 years (SD = 9.8) and average daily exercise duration was 14.0 min (SD = 15.4). Participants

Discussions

Our findings indicated that regular exercise, either Tai-chi or aerobic training, showed positive benefits in attention, memory, manifestation of psychiatric symptoms, daily living abilities, as well as motor and sequencing functioning over the control group. Our findings were consistent with previous research on the beneficial impacts of exercise in psychiatric rehabilitation (Koivukangas et al., 2009, Levin and Gimino, 1982, Lin et al., 2011, Visceglia and Lewis, 2011), although the present

Role of the funding source

This study was funded by the General Research Fund, Research Grants Council (GRF/HKU 744912). The Research Grants Council was not involved in study design, in the collection, analysis, and interpretation of data, in the writing of the article, or in the decision to submit the article for publication.

Contributors

RTHH, FSWAY and PHYL conceived and designed the study. RTHH, TCTF and AHYW searched the literature. AHYW, IKMC, CPKW and WYHN assisted in data collection. TCTF performed the data analysis and interpreted the data. RTHH, TCTF and AHYW drafted the manuscript. TCTF, RTHH, AHYW, SMN, CLWC and EHYC critically reviewed the manuscript for important intellectual contents.

All authors contributed to and have approved the final version of the manuscript. RTHH obtained funding and supervised the study.

Conflict of interest

The authors declared that there is no conflict of interest related to this study.

Acknowledgments

The authors would like to thank Mr. Joey Siu, Ms. Sharon Tam, and the staff of the Providence Garden for Rehab for their help with data collection and study coordination and Ms. Irene Cheung for coordinating the collection and laboratory analysis of the salivary cortisol data. This study was funded by the General Research Fund, Research Grants Council (GRF/HKU 744912).

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