Investigating the benefits of exercise for early psychosis

Physical exercise is widely accepted as having a plethora of physical and psychological benefits for the general population, including weight management, cardio-metabolic risk reduction, mood improvement and cognitive enhancement. This broad spectrum of beneficial effects has led to considerable research interest into how exercise may be applied with clinical care and treatment of people with severe mental illnesses, such as schizophrenia. Indeed, exercise interventions have been found to improve outcomes in people with schizophrenia, perhaps through providing effective adjunctive treatment for the various physical and mental health issues which are not resolved (or even worsened) by antipsychotic treatment. Exercise may be particularly useful when implemented in the early stages of schizophrenia, i.e. first-episode psychosis (FEP), in order to prevent obesity and cardiometabolic diseases from arising, and facilitate psychosocial recovery before enduring disability takes hold. However, the feasibility and effectiveness of exercise in this population is not well understood. In this thesis, I combine both meta-analytic and experimental methods to examine the effectiveness of physical exercise as an adjunctive treatment for the symptoms and cognitive dysfunction associated with psychotic disorders, and to investigate the feasibility of using individualised exercise training as an intervention in FEP. Furthermore, using both qualitative and quantitative data sources, I investigate the factors which may influence the effectiveness of exercise interventions for people with psychotic disorders, and explore motivations and barriers towards physical activity in this patient group. My investigations show that exercise can be used to target unmet treatment needs in FEP (i.e. improving negative symptoms and cognition), which may facilitate early recovery. However, results also indicate that exercise effectiveness is ultimately dependent upon participants achieving and maintaining sufficient weekly amounts of activity, therefore emphasizing the importance of developing acceptable interventions. I further show, using both qualitative and quantitative data sources, that social support and autonomy are critical factors determining exercise adherence - with individualised exercise training presenting an effective method for fulfilling these requirements, and promoting exercise engagement in FEP. I conclude by commenting on developments within the literature, identifying outstanding questions and discussing the clinical implications of the evidence to date, along with proposing a novel and potentially feasible system for providing exercise treatments to people with FEP, in order to improve physical health and facilitate recovery.