Impact of Structured Physical Exercise Programs (SPEs) on Symptoms and Clinical Outcomes in Schizophrenia: A Systematic Review With Qualitative Synthesis of Randomized Controlled Trials (2015–2025)

Abstract

Background: People with schizophrenia present persistent deficits that are poorly responsive to pharmacological treatment, particularly including negative symptoms and cognition. Recent evidence indicates that structured physical exercise programs (SPEs) can modulate relevant neurobiological mechanisms and improve essential clinical outcomes. Given the heterogeneity of existing protocols, a systematic synthesis of this evidence is necessary. The aim of this study was to investigate the effects of SPEs on symptomatology, cognition, global functioning, and physical fitness in individuals with schizophrenia.

Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with searches conducted in the PubMed/Medline, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Virtual Health Library (VHL) databases. Randomized clinical trials with adults diagnosed with schizophrenia who underwent structured exercise interventions were included. Initial searches identified 756 records, of which 16 studies were included in the review and comprised the final synthesis. Data extraction followed a standardized form, and study characteristics are described using descriptive statistics. 

Results: The included trials demonstrated consistent effects of different categories of physical exercise on negative symptoms, general symptoms, and overall functioning related to physical fitness, as well as improvements in cognitive aspects. A variety of SPE protocols were observed, as well as different intensities and instruments for evaluating the effectiveness of the interventions. Regarding intensity, it was noted that low-intensity SPEs also produced benefits, especially in institutionalized contexts; however, the metabolic effects were less consistent. Furthermore, the heterogeneity of the protocols influenced the magnitude of the results.

Conclusions: SPEs generate positive clinical impacts that are adaptable to the needs of each patient, an essential aspect given the common barriers observed in the diagnosis of schizophrenia. The findings support the integration of SPEs into mental health services, as a component capable of expanding clinical and functional outcomes, and offering an accessible intervention aligned with the needs of this population.