Kimhy David, Ospina Luz H, Wall Melanie, Alschuler Daniel M, Jarskog Lars F, Ballon Jacob S, McEvoy Joseph, Bartels Matthew N, Buchsbaum Richard, Goodman Marianne, Miller Sloane A, Stroup T Scott
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, New York, NY, 10029, United States, 1 212-585-4656.
New York Mental Illness Research Education and Clinical Center (NY MIRECC), James J. Peters VA Medical Center, New York, NY, United States.
JMIR Ment Health. 2025 Feb 14;12:e68251. doi: 10.2196/68251.
Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present, there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population.
To examine the feasibility, safety, and efficacy of trainer-led, at-home, telehealth-based AE in individuals with schizophrenia.
We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home, telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of the delivery of trainer-led AE training among participants undergoing in-person (pre-COVID-19; n=23) versus at-home telehealth AE (post-COVID-19; n=14).
The telehealth and in-person participants attended a similar number of exercise sessions across the 12-week interventions (26.8, SD 10.2 vs 26.1, SD 9.7, respectively; P=.84) and had similar number of weeks with at least 1 exercise session (10.4, SD 3.4 vs 10.6, SD 3.1, respectively; P=.79). The telehealth-based AE was associated with a significantly lower drop-out rate (telehealth: 0/14, 0%; in-person: 7/23, 30.4%; P=.04). There were no significant group differences in total time spent exercising (telehealth: 1246, SD 686 min; in-person: 1494, SD 580 min; P=.28); however, over the 12-week intervention, the telehealth group had a significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3%, SD 21.4%; in-person: 63.5%, SD 16.3%; P<.001). There were no AE-related serious adverse events associated with either AE delivery format. Similarly, there were no significant differences in the percentage of participants experiencing minor or moderate adverse events, such as muscle soreness, joint pain, blisters, or dyspnea (telehealth: 3/14, 21%; in-person: 5/19, 26%; P>.99) or in the percentage of weeks per participant with at least 1 exercise-related adverse event (telehealth: 31%, SD 33%; in-person: 40%, SD 33%; P=.44). There were no significant differences between the telehealth versus in-person groups regarding changes in aerobic fitness as indexed by maximum oxygen consumption (VO2max; P=.27).
Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings' clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for the implementation of telehealth-based AE among people with schizophrenia.
有氧运动（AE）训练已被证明可提高精神分裂症患者的有氧适能。传统上，此类训练是在健身房或其他公共运动场所亲自进行的。然而，自COVID-19大流行出现后，许多诊所将其服务转变为基于远程医疗的提供方式。然而，目前关于该人群中基于远程医疗的有氧运动的可行性、安全性和有效性的信息稀缺。
研究由教练指导的、基于家庭远程医疗的有氧运动对精神分裂症患者的可行性、安全性和有效性。
我们分析了一项单盲随机临床试验中有氧运动组（n = 37）的数据，该试验考察了为期12周的有氧运动干预对精神分裂症患者的影响。在COVID-19大流行开始后，有氧运动试验干预从亲自进行转变为基于家庭远程医疗的有氧运动，训练频率和持续时间保持不变。我们比较了亲自进行有氧运动训练（COVID-19之前；n = 23）与家庭远程医疗有氧运动（COVID-19之后；n = 14）的参与者中由教练指导的有氧运动训练的可行性、安全性和有效性。
在为期12周的干预中，远程医疗组和亲自参与组参加的锻炼课程数量相似（分别为26.8次，标准差10.2；26.1次，标准差9.7；P = 0.84），且至少有1次锻炼课程的周数相似（分别为10.4周，标准差3.4；10.6周，标准差3.1；P = 0.79）。基于远程医疗的有氧运动的退出率显著更低（远程医疗：0/14，0%；亲自参与：7/23，30.4%；P = 0.04）。锻炼总时长无显著组间差异（远程医疗：1246分钟，标准差686；亲自参与：1494分钟，标准差580；P = 0.28）；然而，在为期12周的干预中，远程医疗组在目标强度或以上强度锻炼的课程时间比例显著更低（远程医疗：33.3%，标准差21.4%；亲自参与：63.5%，标准差16.3%；P < 0.001）。两种有氧运动提供形式均未出现与有氧运动相关的严重不良事件。同样，在经历轻微或中度不良事件（如肌肉酸痛、关节疼痛、水泡或呼吸困难）的参与者百分比方面（远程医疗：3/14，21%；亲自参与：5/19，26%；P > 0.99）或每位参与者至少有1次与锻炼相关不良事件的周数百分比方面（远程医疗：31%，标准差33%；亲自参与：40%，标准差33%；P = 0.44）均无显著差异。在以最大耗氧量（VO2max）为指标的有氧适能变化方面，远程医疗组与亲自参与组之间无显著差异（P = 0.27）。
我们的研究结果为向精神分裂症患者提供基于远程医疗的有氧运动提供了初步支持。我们的结果表明，基于家庭远程医疗的有氧运动在该人群中是可行且安全的，尽管在可行的情况下，考虑到社交互动的机会和更高强度的锻炼，亲自进行有氧运动似乎更可取。我们讨论了研究结果的临床意义，特别是在COVID-19大流行的背景下，并审视了在精神分裂症患者中实施基于远程医疗的有氧运动的潜在挑战。
