What is it about?

Cognitive training benefits the functioning of people living with serious mental illness (SMI). However, contrary to data observed in other groups, in individuals living with SMI moderate aerobic exercise did not appear to enhance cognitive improvements conferred by cognitive training nor did it appear to increase serum levels of brain derived neurotrophic factor (BDNF) - a protein hypothesized to facilitate brain plasticity.

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Why is it important?

While the trend in the general population seems to point to a clear benefit on BDNF levels and cognitive function, moderate exercise does not appear to confer a similar benefit on individuals living with SMI. While this could be due to exceptionally strong gains from the cognitive training component in both groups, it is worth considering a number of other factors, for instance metabolic effects of medications and body mass index. It is also worth studying whether exercise "distress" tolerance is lower in the SMI population (i.e., for two individuals with comparable levels of "physiological" fitness [e.g., VO2 MAX], the same amount of work results in higher levels of perceived exertion).

Perspectives

I suspect another study, implemented differently, *might* be able to find an effect of exercise in the population of interest (i.e., persons living with SMI). Limitations of this study's protocol: -During exercise, physiological monitoring was intermittent and conducted with a fingertip pulse oximeter in this study ... this was frankly substandard signal capture on a non-continuous basis. Future studies should employ an ambulatory ECG/Cheststrap monitor that [continuously] captures R-R intervals and can thus be used to calculate HRV measures as well as provide constant feedback on exertion level for participants and study personnel. -The exercise protocol itself was not metabolically optimal and emphasized moderate intensity, steady-state exercise. If the population of interest could tolerate it, high-intensity interval training (HIIT) would be a far preferable metabolic protocol to employ in tandem with predominantly bodyweight-oriented resistance movements. HIIT training has been shown to be a far more potent elicitor of BDNF response than steady state exercise.

Zachary Cutler
Boston University

Read the Original

This page is a summary of: A randomized controlled trial of exercise on augmenting the effects of cognitive remediation in persons with severe mental illness, Journal of Psychiatric Research, July 2021, Elsevier,
DOI: 10.1016/j.jpsychires.2021.04.033.
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