統合失調症スペクトラム障害における構造化運動の効果に関する系統的レビューおよびメタアナリシス

Individuals with schizophrenia spectrum disorders experience impairments across multiple domains, including cognition, quality of life, and social functioning. Structured exercise interventions may improve these outcomes. We hypothesised that aerobic and combined (aerobic plus resistance) exercise programs would enhance cognitive function, reduce symptom severity, and improve well-being.

A PRISMA-guided search of PubMed, EMBASE, PsycINFO, Web of Science, SciELO, and ClinicalTrials.gov (2009-2024) identified 17 randomized controlled trials. Standardized mean differences (SMDs) were pooled using a random-effects model. Subgroup analyses examined age and gender. Risk of bias was assessed using RoB 2, publication bias with Egger's test, and certainty of evidence through GRADE.

Structured exercise produced a moderate-to-large improvement in overall well-being (SMD = 0.68; 95% CI: 0.43-0.93; p < .001). Significant benefits were also observed in cognition (SMD = 0.59), symptom severity (SMD = 0.71), quality of life (SMD = 0.60), and social functioning (SMD = 0.55). Age and gender moderated treatment effects, with the strongest benefits in males and individuals aged 36-45. Sensitivity analyses confirmed the robustness of results. Mechanistic evidence suggests that improvements may be mediated through increased brain-derived neurotrophic factor (BDNF) and reduced inflammatory signaling.

Structured exercise is an effective adjunctive intervention for schizophrenia spectrum disorders, improving psychiatric and functional outcomes beyond standard care. Findings support the integration of personalized, scalable exercise programs within routine psychiatric treatment.