A combined exercise and cognitive training intervention induces fronto-cingulate cortical plasticity in first-episode psychosis patients

Schizophr Res. 2023 Jan:251:12-21. doi: 10.1016/j.schres.2022.12.001. Epub 2022 Dec 15.


Objective: Schizophrenia (SZ) is characterized by neurobiological and associated cognitive and functional deficits, including pronounced cortical thinning, that lead to acute and long-term functional impairment. Research with older adults supports the role of non-pharmacological interventions, such as exercise (E) and cognitive training (CT), for cognitive impairments. This literature influenced the development of combined CT&E treatments for individuals with SZ. However, the impact of longer combined treatment duration (6 months) on neuroanatomy has yet to be explored in patients in the early course of the illness. The impact of adding exercise to cognitive training for key brain regions associated with higher-order cognition was examined here using magnetic resonance imaging (MRI) in first-episode psychosis (FEP) patients.

Methods: UCLA Aftercare Research Program patients with a recent first episode of schizophrenia were randomly assigned to either combined cognitive and exercise training (CT&E) (N = 20) or cognitive training alone (CT) (N = 17) intervention. Cortical thickness was measured longitudinally and analyzed for two regions of interest using FreeSurfer.

Results: Compared to patients in the CT group, those in the CT&E group demonstrated an increase in cortical thickness within the left anterior cingulate cortex over the six-month treatment period (ACC: F(1, 35) = 4.666, P < .04). Directional tendencies were similar in the left dorsolateral prefrontal cortex (DLPFC: F(1,35) = 4.132, P < .05).

Conclusions: These findings suggest that exercise and cognitive training may synergistically increase fronto-cingulate cortical thickness to mitigate progressive neural atrophy in the early course of SZ. This combined intervention appears to be a valuable adjunct to standard pharmacologic treatment in FEP patients.

Trial registration: ClinicalTrials.gov NCT02267070.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cognitive Training
  • Exercise
  • Gyrus Cinguli
  • Humans
  • Magnetic Resonance Imaging / methods
  • Psychotic Disorders* / diagnostic imaging
  • Psychotic Disorders* / pathology
  • Psychotic Disorders* / therapy
  • Schizophrenia* / drug therapy
  • Schizophrenia* / therapy

Associated data

  • ClinicalTrials.gov/NCT02267070