Schizophrenia is complex, as is its treatment. But therapy in the future could involve getting back to basics. Doctor’s orders may include this advice: “Take two laps around the running track and call me in the morning.”
It’s not nearly that simple, of course, but research out of the University of British Columbia has found that exercise can improve some of the disorder’s most troubling effects.
Dr. William Honer, director of the UBC Institute of Mental Health, explains that the hippocampus, an area of the brain associated with memory, is smaller in those with schizophrenia than in healthy people. However, aerobic exercise seems to increase the volume of the hippocampus, improving brain functioning and overall symptoms as a result.
“We did brain scans on people before and after beginning an exercise program, and it actually improved the structure of the hippocampus,” Honer, in a phone interview, says of the 2010 study published in the Archives of General Psychiatry. “We found it increased in size. In healthy people who were sedentary, their hippocampus increased and improved too. This is exciting because we often think of schizophrenia deficiencies as losses in brain tissue, but this told us that there’s plasticity there, and it could possibly have a regenerative capacity in response to this intervention.
“My colleagues are calling it an exercise prescription,” adds Honer, who also holds the Jack Bell Chair in Schizophrenia and is head of the UBC faculty of medicine’s psychiatry department. “It can make a difference.”
Current research that Honer is involved in is replicating those promising findings. It’s taking place locally, through the B.C. Psychosis Program (for which Honer is a consulting psychiatrist), and at the University of Hong Kong. Although not yet published, an abstract of the latter study was presented at the fourth biennial Schizophrenia International Research Conference in Italy last month. Researchers studied the effects of aerobic exercise and yoga on cognitive functioning and clinical symptoms in female schizophrenia patients with early psychosis.
Those who did both forms of movement demonstrated significant improvements in short- and long-term memory, depressive symptoms, and overall clinical symptoms, with patients in the yoga group showing markedly enhanced attention and concentration. Brain scans showed greater cortical thickness and volume, indicating improved neurogenesis (the growth and development of new neurons).
What makes the “exercise prescription” especially promising is that antipsychotic drugs don’t appear to correct low hippocampal volume in schizophrenia, although research in that area is lacking.
Honer is quick to point out that exercise wouldn’t replace existing treatments, such as medication and psychotherapy, but would be used in conjunction with them.
What makes schizophrenia so hard to treat is that it’s a multifaceted condition, Honer explains. Psychotic behaviour, or disconnection from reality, is just one component that falls into the category of “positive” symptoms—those not normally experienced by individuals without schizophrenia. The disease also involves “negative” symptoms, such as the loss of ability to experience strong emotions, difficulty making social connections, and lack of enjoyment of everyday life. Then there are accompanying cognitive impairments: memory problems and difficulty concentrating and planning.
“The illness really can’t be reduced to simple cause and effect,” Honer says. “It’s not as simple as, ‘If you take this treatment, you’ll be cured.’ It’s very challenging [to treat], but on the other hand, we do have effective treatments for certain components of the illness.
“It’s the positive symptoms, the psychosis, that get people into trouble in an acute way, but it’s the negative symptoms and the cognitive problems that really impair function, the ability to get back to school, problems with relationships, and the ability to work,” he adds. “Those are the things we really need to work on.”
Not surprisingly, getting money for research that looks at the effectiveness of exercise and mind-body practices like yoga has proved challenging, in part because most major clinical trials are funded by drug companies. Honer credits the Provincial Health Services Authority for being supportive of this type of research. However, he notes that far more resources will be required if a healthy dose of exercise is to become part of a successful treatment plan for schizophrenia.
“I’m optimistic this could become part of a treatment program for the rehabilitation and the improvement of patients,” he says. “But not just one lonely exercise bicycle on the ward is going to do it. If we’re going to do this, we do need programs with trainers, particularly with inpatients—people who are severely ill and need help with motivation and training. They need to stay on their medication, too, so we need professionals looking at that and making sure they can work in an exercise program that’s safe with their medications.”
Aside from an integrated approach, individualized care is crucial, he says.
“I don’t think personalized medicine is all about drugs or all about genetics,” he adds. “Personalized medicine is what is best for individual patients, using whatever range of treatments and interventions we can use. Each patient has to be treated as an individual, looked at as a person to help improve their illness and make their quality of life better.”
Translating research into clinical care and practice is one of Honer’s priorities and helps make his work so rewarding.
“Part of our mission is to benefit all of the citizens of our province and all of our patients who need help,” Honer says. “More than 40,000 people have schizophrenia in B.C. There’s a lot of need out there.
“Research has a part of creativity to it that I find stimulating,” he says. “You have to have new ideas, novel ways of looking at things, but you have to understand the history and the past, too. This [research] is novel. It’s looking at body health as well as brain health and mind health; they’re all linked together.”