Two is Better Than One: Potentiating Cognitive Remediation With Aerobic Exercise to Improve Cognition in Schizophrenia With a Randomized Controlled Trial

Background: Cognitive impairment is a core feature of schizophrenia, for which pharmacological interventions have limited efficacy. Cognitive remediation (CR) is the gold standard for addressing cognitive deficits, yet its effect remains in the low-to-medium range, thus enhanced treatment approaches are needed. Emerging evidence supports the cognitive benefits of Aerobic Exercise (AE), suggesting that a combined intervention of AE and CR could lead to greater cognitive enhancements. This study aims at evaluating, with a randomized controlled trial, cognitive improvements following a combined intervention of CR+AE, compared to either CR or AE alone in patients diagnosed with schizophrenia. Methods: Sixty patients with schizophrenia were randomized into three groups (AE, CR, or CR+AE), and assessed for cognition, with the MATRICS Consensus Cognitive Battery at baseline, post-intervention, and at a 3-month follow-up. Results: CR+AE group showed significantly greater improvements in several domains including attention (p = 0.02), verbal learning (p = 0.03), and working memory (p = 0.04) compared to CR group, as well as processing speed (p = 0.002), verbal learning (p = 0.03), and working memory (p = 0.05) compared to AE group. At 3-months follow-up, evaluating CR+AE vs CR, further significant improvements were observed for social cognition (p = 0.01) in the CR+AE group, as well as for processing speed (p = 0.03) in the CR group. Conclusions: While preliminary, these findings suggest that a combined intervention of CR+AE allows greater improvements across core cognitive domains. In a wider perspective, this study also underscores the potential value of implementing aerobic exercise in rehabilitative approaches aimed at addressing cognitive dysfunction in schizophrenia.