Schizophrenia Research 173 (2016) 116–117

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Schizophrenia Research

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Letter to the Editor

The impact of aerobic exercise training on
cardiopulmonary functioning in individuals
with schizophrenia
Low aerobic fitness is ubiquitous among individuals with schizo-
phrenia (Kimhy et al., 2014; Strassnig et al., 2011) and is linked to a
wide range of cardiopulmonary and metabolic problems
(Vancampfort et al., 2015a; Vancampfort et al., 2015b). However, previ-
ous reports examined only a limited range of exercise parameters, pri-
marily VO2max or VO2peak (Heggelund et al., 2011; Vancampfort
et al., 2015b). Thus, our aim was to examine the impact of aerobic exer-
cise (AE) training on multiple parameters of exercise capacity including
heart rate (HR), respiratory exchange ratio (RER), resting and peak sys-
tolic and diastolic blood pressure (SBP, DBP), absolute peak oxygen up-
take (VO2 mL/kg/min), peak minute ventilation (VE), peak tidal volume
(Vt), end tidal carbon dioxide pressure (PetCO2), rate of carbon dioxide
production at peak (VCO2 L/min), and peak work rate (watts). Partici-
pants also completed a 6MWT (ATS Statement, 2002).
Employing a single-blind, randomized clinical trial design, partici-
pants were randomized to receive 12 weeks of Treatment-as-Usual
(TAU) or attend AE training, in addition to TAU. Detailed inclusion and
exclusion criteria as well at the study protocol (Kimhy et al., 2015a)
and training program (Kimhy et al., 2015b) have been previously pub-
lished. Briefly, participants were randomized to receive 12 weeks of
standard psychiatric treatment (TAU) or attend three one-hour AE ses-
sions per week for 12 weeks, in addition to receiving standard care.
Training intensity was set for each participant individually based on
his/her peak heart rate (HR), as determined during his or her baseline
CPET.
Thirty-three individuals with schizophrenia and related disorders
were randomized (16 AE, 17 TAU), of whom 26 completed the study
(79%; 13 AE, 13 TAU). There were no significant baseline differences be-
tween the TAU and AE groups in terms of CPET, demographics or 6MWT
variables, with the exception of the 6MWT dyspnea score was higher in
the control group (TAU: 0.91 ± 1.2, AE: 0.39 ± 0.58, p-value = 0.01).
Table 1 shows the baseline and follow-up CPET and 6MWT results for
both the AE and TAU groups. The AE group significantly increased
their peak VO2, VCO2, watts, VE, and dyspnea score. In contrast, there
were no significant changes in the TAU on any parameter.
The results extend previous studies by demonstrating that a 12-
week AE training program significantly increases numerous cardiopul-
monary fitness parameters (peak VO2, VE, VCO2 and watts) in individ-
uals with schizophrenia compared to individuals with schizophrenia

Table 1
Changes in cardiopulmonary and behavioral fitness parameters from baseline to follow-up among the aerobic exercise and treatment-as-usual groups.

Treatment-as-usual p-Value Aerobic exercise p-Value

Baseline Follow-up Baseline Follow-up

Cardiopulmonary exercise test

VO2 peak (mL/kg/min) 22.17 ± 4.76 21.69 ± 3.73 0.58 20.62 ± 5.55 24.4 ± 7.31 0.001
VO2% predicted 81 ± 20% 80 ± 20% 0.91 72 ± 20% 83 ± 21% 0.001
VCO2 peak (L/min) 2.16 ± 0.70 2.13 ± 0.70 0.58 2.02 ± 0.78 2.37 ± 1.00 0.01
RER 1.04 ± 0.09 1.03 ± 0.09 0.78 1.04 ± 0.12 1.05 ± 0.17 0.68
Watts peak 129 ± 37 126 ± 41 0.48 120 ± 44 130 ± 47 0.01
Watts % predicted 72 ± 16% 70 ± 17% 0.42 62 ± 16% 68 ± 16% 0.01
VE peak (L) 64.7 ± 17.5 63.5 ± 20.2 0.65 58 ± 25 70 ± 31 0.02
VE/VCO2 30.5 ± 2.7 30.1 ± 2.6 0.59 28.6 ± 3.9 29.6 ± 3.8 0.12
Vt peak 1.65 ± 0.39 1.60 ± 0.43 0.40 1.55 ± 0.49 1.70 ± 0.53 0.11
PetCO2 peak (mm Hg) 37.0 ± 2.32 37.0 ± 2.42 0.97 39.4 ± 5.5 38.2 ± 4.1 0.14
SBP base (mm Hg) 112 ± 11 112 ± 8 0.85 113 ± 15 111 ± 15 0.59
SBP peak (mm Hg) 168 ± 17 167 ± 21 0.77 164 ± 20 164 ± 24 0.99
DBP base (mm Hg) 73 ± 8 71 ± 9 0.38 70 ± 8 73 ± 9 0.23
DBP peak (mm Hg) 77 ± 9 74 ± 9 0.32 78 ± 9 78 ± 9 0.25

6-minute walk testa

6MWT distance 1426 ± 163 1451 ± 232 0.84 1399 ± 222 1487 ± 240 0.13
6MWT dyspnea score 0.91 ± 1.2 0.64 ± 1.00 0.53 0.39 ± 0.58 0.12 ± 0.22 0.05
6MWT fatigue score 0.50 ± 0.63 0.77 ± 1.08 0.40 0.50 ± 0.65 0.19 ± 0.56 0.15

Other
BMI 31.4 ± 4.9 31.6 ± 5.2 0.29 31.8 ± 6.7 31.9 ± 6.6 0.81
Weight (kg) 92.9 ± 16.1 93.6 ± 17.1 0.27 94.6 ± 20.1 94.8 ± 19.2 0.88

N = 26 (aerobic exercise = 13, treatment-as-usual = 13); Bold p-value indicates p ≤ 0.05; VO2—volume of oxygen consumed; VCO2—rate of carbon dioxide production; RER—respiratory
exchange ratio; VE—minute ventilation; HR—heart rate; Vt—tidal volume; PetCO2: partial pressure of end-tidal carbon dioxide; SBP—systolic blood pressure; DBP—diastolic blood pres-
sure; BMI—body-mass index.
a
There were 11 participants in the control group who completed the 6MWT.

http://dx.doi.org/10.1016/j.schres.2016.03.009
0920-9964/© 2016 Elsevier B.V. All rights reserved.
 Letter to the Editor 117

receiving TAU. Parameters beyond VO2 are important to show, as they Vancampfort, D., Rosenbaum, S., Probst, M., Soundy, A., Mitchell, A.J., De Hert, M., Stubbs,
B., 2015b. Promotion of cardiorespiratory fitness in schizophrenia: a clinical overview
have previously not been widely published in this population. Specifi- and meta-analysis. Acta Psychiatr. Scand. 132 (2), 131–143.
cally, the VE and 6MWT dyspnea scores improved, indicating an en- Vancampfort, D., Rosenbaum, S., Ward, P.B., Stubbs, B., 2015c. Exercise improves cardiore-
hanced ventilatory response to exercise, previously undocumented. spiratory fitness in people with schizophrenia: a systematic review and meta-
analysis. Schizophr. Res. 169 (1–3), 453–457.
Additionally, the high RER at both tests in this population shows that
they were able to exercise to a high level and reach and maintain their
Hilary F. Armstrong
target heart rates during training. This point may have particular clinical
Department of Rehabilitation and Regenerative Medicine, College of
application, as recent reports indicate fidelity with target training inten-
Physicians and Surgeons, Columbia University, New York, NY, USA
sity is strongly linked to cognitive benefits from AE (Kimhy et al., 2016).
Department of Epidemiology, Mailman School of Public Health, Columbia
Of interest, there was no change in BMI, weight or peak hemodynamic
University, New York, NY, USA
parameters with the intervention, while peak performance increased
Corresponding author at: 622W168th Street, HP 1-169b, New York,
after exercise, implying a good training effect. This allowed higher per-
NY 10032, USA.
formance with similar RER (an indicator of effort), peak heart rates and
E-mail address: hfa2104@columbia.edu.
blood pressures, demonstrating a true training effect in the AE group.
Given the sedentary nature of this population, it is important to recog-
Matthew N. Bartels
nize these attainable cardiopulmonary benefits over a relatively short
Department of Rehabilitation Medicine, Albert Einstein College of Medicine,
(12 week) duration (Vancampfort et al., 2015c). Our results are partic-
Bronx, NY, USA
ularly meaningful given the high BMI of participants in our study
(mean = 31.4) compared to previous reports by Heggelund et al.
Orest Paslavski
(2011)) (mean = 28.3) and Scheewe (2012)) (means = 26.6 & 26.0).
Darnell Cain
Hannah A. Shoval
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