Cognitive training combined with aerobic exercise improves negative symptoms in recent-onset schizophrenia: Results from a 12-month randomized trial
In brief
Adding aerobic exercise sustained symptom improvement after six months in early schizophrenia
In a 12-month randomized trial of 65 people with recent-onset schizophrenia, both groups improved during the first six months, but those receiving aerobic exercise alongside cognitive training continued to improve on negative symptoms afterward. The findings suggest exercise may add benefit over time, though negative symptoms were a secondary outcome and the trial was small.
- Journal
- Schizophrenia research (Q1)
- Published
- 28 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Joseph Ventura, Kenneth L Subotnik, Sarah C McEwen, Fiona G Whelan, Laurie R Casaus, Emily A McGraw, et al.
- PMID
- 42950689
- DOI
- 10.1016/j.schres.2026.09.016
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 31 October 2026): Randomized trial finds exercise may improve negative symptoms
Abstract
BACKGROUND: Negative symptoms are often considered as a core feature of schizophrenia. High initial severity levels are predictive of poor clinical outcomes, and negative symptoms are often considered notoriously difficult to treat. However, some research indicates that combining cognitive training with aerobic exercise yields notable improvements in negative symptoms for individuals with multi-episode schizophrenia. METHOD: Our Randomized Controlled Trial (RCT) compared the impact of 12 months of Cognitive Training combined with Aerobic Exercise (CT&E) compared to Cognitive Training (CT) alone in 65 first episode schizophrenia patients (73% male; age = 22.5 years; education = 12.8 years). All participants were provided with cognitive training and the CT&E group also participated in an aerobic exercise program. Negative Symptoms were assessed with the SANS at baseline and subsequently every 2-weeks. Negative symptoms were secondary outcomes from our original RCT (Nuechterlein et al. 2023) and considered of high clinical relevance because of their relationship to functional outcome. RESULTS: Piecewise Linear Mixed Effects Models showed an overall differential effect of treatment over 12 months in which the intervention groups improved at similar rates over the first 6 months, while the CT&E group continued to improve on SANS Total Score (p < 0.001). Similar patterns were observed on SANS Expressive and Experiential domains. CONCLUSIONS: These findings indicate that aerobic exercise, when combined with cognitive training, can improve both expressive and experiential negative symptoms in individuals living with schizophrenia. The results extend the potential for exercise-based interventions to promote negative symptom reduction during a critical "early phase" that may impact long-term outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.