Bernard P, Ninot G
Laboratoire Epsylon EA, dynamique des capacités humaines et des conduites de santé, université Montpellier-1, Montpellier, France.
Encephale. 2012 Sep;38(4):280-7. doi: 10.1016/j.encep.2011.07.001. Epub 2011 Oct 11.
Previous reviews of exercise and mental health have predominantly examined chronic illness and more recently, several psychiatric disorders. There is growing evidence that exercise can also be an effective treatment for major depressive disorders, anxiety disorders and alcohol dependence. Individuals with schizophrenia are more likely to be sedentary than the general population.
The objectives of this systematic review are to analyse the habits of physical activity and examine the literature that has investigated the use of exercise as treatment for schizophrenia.
We systematically reviewed psycINFO, Medline/PubMed, SportDiscus, Web of Sciences, and Cochrane Library. The searches of databases were conducted from database inception until September 2010, using a range of search terms to reflect both physical activity and schizophrenia. Studies were subsequently considered eligible if they reported on quantitative studies investigating the effect of physical activity upon some aspect of physical or mental health in individuals with schizophrenia.
Of the 139 articles retrieved, 19 studies met the inclusion criteria. In controlled studies, most authors have underlined the benefits of aerobic exercises. These programs may act both on positive symptoms (hallucinations) and on negative symptoms. According to certain studies, the positive effect may appear in a short time and at the end of the program. No studies assess long-term benefits. Small samples of self selected participants, inadequately selected control groups are common methodological weaknesses. A recent research has directly investigated the potential mechanism underpinning the positive benefits. The results indicated that hippocampal volume is plastic in response to aerobic exercise.
We discuss methodological and practical challenges to research in this area, and outline several research questions that future work should seek to address. Existing studies do suggest that lifestyles, physical activity interventions, or regular exercise programmes are possible in this population and can have beneficial effects on both the mental and physical health and well being of individuals with schizophrenia.
Research into the efficacy and safety of exercise as an intervention in schizophrenia is required to support the development of detailed, population-specific guidelines. Larger randomised studies are required before any definitive conclusions can be drawn. Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have beneficial effects on both physical and mental health. Future research should address issues of programme adherence.
以往关于运动与心理健康的综述主要关注慢性病，最近也涉及了几种精神疾病。越来越多的证据表明，运动也可以成为治疗重度抑郁症、焦虑症和酒精依赖的有效方法。与普通人群相比，精神分裂症患者更倾向于久坐不动。
本系统综述的目的是分析身体活动习惯，并研究有关将运动用作精神分裂症治疗方法的文献。
我们系统地检索了心理学文摘数据库（PsycINFO）、医学数据库（Medline/PubMed）、体育文献数据库（SportDiscus）、科学引文索引数据库（Web of Sciences）和考克兰图书馆。从各数据库创建之初至2010年9月进行数据库检索，使用一系列检索词以涵盖身体活动和精神分裂症两方面。如果研究报告了关于调查身体活动对精神分裂症患者身体或心理健康某些方面影响的定量研究，则这些研究随后被视为符合纳入标准。
在检索到的139篇文章中，有19项研究符合纳入标准。在对照研究中，大多数作者强调了有氧运动的益处。这些项目可能对阳性症状（幻觉）和阴性症状都有作用。根据某些研究，积极效果可能在短期内以及项目结束时出现。没有研究评估长期益处。自我选择参与者的小样本、选择不当的对照组是常见的方法学弱点。最近的一项研究直接调查了产生积极益处的潜在机制。结果表明，海马体体积会因有氧运动而具有可塑性。
我们讨论了该领域研究在方法学和实践方面的挑战，并概述了未来研究应设法解决的几个研究问题。现有研究确实表明，在这一人群中开展生活方式、身体活动干预或定期运动项目是可行的，并且对精神分裂症患者的身心健康和幸福感都能产生有益影响。
需要对运动作为精神分裂症干预措施的疗效和安全性进行研究，以支持制定详细的、针对特定人群的指南。在得出任何明确结论之前，需要进行更大规模的随机研究。尽管本综述纳入的研究规模较小，且使用了各种身心健康测量方法，但结果表明，在这一人群中开展定期运动项目是可行的，并且对身心健康都能产生有益影响。未来的研究应解决项目依从性问题。
