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      Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis

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          Abstract

          Cognitive deficits are pervasive among people with schizophrenia and treatment options are limited. There has been an increased interest in the neurocognitive benefits of exercise, but a comprehensive evaluation of studies to date is lacking. We therefore conducted a meta-analysis of all controlled trials investigating the cognitive outcomes of exercise interventions in schizophrenia. Studies were identified from a systematic search across major electronic databases from inception to April 2016. Meta-analyses were used to calculate pooled effect sizes (Hedges g) and 95% CIs. We identified 10 eligible trials with cognitive outcome data for 385 patients with schizophrenia. Exercise significantly improved global cognition ( g = 0.33, 95% CI = 0.13–0.53, P = .001) with no statistical heterogeneity ( I 2 = 0%). The effect size in the 7 studies which were randomized controlled trials was g = 0.43 ( P < .001). Meta-regression analyses indicated that greater amounts of exercise are associated with larger improvements in global cognition (β = .005, P = .065). Interventions which were supervised by physical activity professionals were also more effective ( g = 0.47, P < .001). Exercise significantly improved the cognitive domains of working memory ( g = 0.39, P = .024, N = 7, n = 282), social cognition ( g = 0.71, P = .002, N = 3, n = 81), and attention/vigilance ( g = 0.66, P = .005, N = 3, n = 104). Effects on processing speed, verbal memory, visual memory and reasoning and problem solving were not significant. This meta-analysis provides evidence that exercise can improve cognitive functioning among people with schizophrenia, particularly from interventions using higher dosages of exercise. Given the challenges in improving cognition, and the wider health benefits of exercise, a greater focus on providing supervised exercise to people with schizophrenia is needed.

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          The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity.

          The lack of an accepted standard for measuring cognitive change in schizophrenia has been a major obstacle to regulatory approval of cognition-enhancing treatments. A primary mandate of the National Institute of Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative was to develop a consensus cognitive battery for clinical trials of cognition-enhancing treatments for schizophrenia through a broadly based scientific evaluation of measures. The MATRICS Neurocognition Committee evaluated more than 90 tests in seven cognitive domains to identify the 36 most promising measures. A separate expert panel evaluated the degree to which each test met specific selection criteria. Twenty tests were selected as a beta battery. The beta battery was administered to 176 individuals with schizophrenia and readministered to 167 of them 4 weeks later so that the 20 tests could be compared directly. The expert panel ratings are presented for the initially selected 36 tests. For the beta battery tests, data on test-retest reliability, practice effects, relationships to functional status, practicality, and tolerability are presented. Based on these data, 10 tests were selected to represent seven cognitive domains in the MATRICS Consensus Cognitive Battery. The structured consensus method was a feasible and fair mechanism for choosing candidate tests, and direct comparison of beta battery tests in a common sample allowed selection of a final consensus battery. The MATRICS Consensus Cognitive Battery is expected to be the standard tool for assessing cognitive change in clinical trials of cognition-enhancing drugs for schizophrenia. It may also aid evaluation of cognitive remediation strategies.
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            A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.

            Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases. The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects. Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.
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              Neurocognitive Deficits and Functional Outcome in Schizophrenia: Are We Measuring the "Right Stuff"?

              There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships.
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                Author and article information

                Journal
                Schizophr Bull
                Schizophr Bull
                schbul
                Schizophrenia Bulletin
                Oxford University Press (US )
                0586-7614
                1745-1701
                May 2017
                12 August 2016
                12 August 2016
                : 43
                : 3
                : 546-556
                Affiliations
                [1 ]Institute of Brain, Behaviour and Mental Health, University of Manchester , Manchester, UK;
                [2 ]Physiotherapy Department, South London and Maudsley NHS Foundation Trust , London, UK;
                [3 ]Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, UK;
                [4 ]Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales , Sydney, New South Wales, Australia;
                [5 ]KU Leuven Department of Rehabilitation Sciences , Leuven, Belgium;
                [6 ]KU Leuven Department of Neurosciences, UPC KU Leuven , Leuven, Belgium;
                [7 ]Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich, Germany;
                [8 ]Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil;
                [9 ]School of Psychological Sciences, University of Manchester , Manchester, UK;
                [10 ]Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA , Los Angeles, CA;
                [11 ]Department of Psychology, University of California, Los Angeles , Los Angeles, CA;
                [12 ]Greater Manchester West NHS Mental Health Foundation Trust , Manchester, UK
                [13 ]These joint-first authors contributed equally to the writing of this manuscript.
                Author notes

                *To whom correspondence should be addressed; Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK; tel: +44 (0)161 306 7914; fax: +44 (0)161 306 7945; e-mail: joseph.firth@ 123456postgrad.manchester.ac.uk

                Article
                sbw115
                10.1093/schbul/sbw115
                5464163
                27521348
                5457334f-1588-413a-aefb-5a222354a72c
                © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 11
                Funding
                Funded by: MRC Doctoral Training Grant
                Funded by: Research Foundation – Flanders
                Funded by: Society for Mental Health Research Early Career Fellowship
                Funded by: NIMH
                Funded by: Janssen
                Funded by: Stanley Medical Research Institute http://dx.doi.org/10.13039/100007123
                Funded by: Posit Science
                Funded by: German Federal Ministry of Education and Research
                Award ID: 01EE1407AE
                Categories
                Regular Article

                Neurology
                physical activity,cognition,neurocognitive,neurocognition,psychosis
                Neurology
                physical activity, cognition, neurocognitive, neurocognition, psychosis

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