Does exercise improve mental focus in people living with schizophrenia?
In a US trial, exercise added to cognitive training improved attention. In Italy, exercise on its own did not beat usual care.
Published 3 min read
This article explains a study published in Schizophrenia Bulletin in 2026. Read the original paper
What the study found
- In 90 young adults after a first episode of schizophrenia, adding exercise to computer-based cognitive training improved attention more than adding a class on healthy living.1
- The more often and the harder people exercised, the more their attention improved.1
- In a trial in Italy, exercise on its own did not improve thinking skills more than usual care; a structured cognitive therapy did.2
The study at a glance
Original paper- Study
- Cognitive training and exercise trial (UCLA)
- Published in
- Schizophrenia Bulletin, 2026
- Design
- Randomised controlled trial, against a group with the same amount of contact time
- Participants
- 90 adults aged 18 to 45 after a recent first episode of schizophrenia
- Where
- University of California, Los Angeles, United States
- Length
- 6 months
- Main result
- Attention score rose 4.6 points with exercise and fell 0.2 without
- Funded by
- US National Institute of Mental Health
- Evidence
- EmergingHow evidence is rated
Clinical summaryFor health professionals
- Design: 90 outpatients aged 18–45 within 2 years of a first episode (mean age 23), on second-generation antipsychotics. All had computerised cognitive training 4 hours a week for 6 months, and were randomised to exercise or a healthy-living class with equal contact time (Nuechterlein 2026).
- Exercise: aerobic intervals with strength training, aiming at 150 minutes a week; two 45-minute supervised group sessions and two 30-minute sessions alone (Nuechterlein 2026).
- Attention (MCCB attention/vigilance T score; population mean 50) rose 4.6 points with exercise and fell 0.2 without, from about 38 at the start (Nuechterlein 2026; Kern 2008).
- The MCCB overall composite rose in both groups, by 5.1 and 4.7 points, with no difference between them (Nuechterlein 2026).
- Blood BDNF is generally lower in schizophrenia (Green 2011) and rises with exercise, clearly after a session and slightly at rest (Szuhany 2015). In this trial (54 participants with samples): +1,095 pg/mL with exercise and −868 pg/mL without at 3 months; +700 and +1,351 at 6 months; the group difference was not significant (Nuechterlein 2026).
- Italy (Deste 2026): 132 outpatients at 7 centres, 15 weeks, twice-weekly sessions in each arm. Exercise: 30 minutes of aerobic training on treadmills or ergometers per session, at 45% rising to 75% of heart-rate reserve. Integrated Neurocognitive Therapy beat usual care on executive function and global cognition (g = 0.79 and 0.82); exercise did not differ from usual care. No group differences in symptoms or functioning.
Why this matters
Problems with attention, memory and planning are a core part of schizophrenia. They make work, study and everyday life harder, and medicines do little for them.2 Two kinds of help have been tested: cognitive training, which practises thinking skills with exercises, often on a computer, and physical exercise.2,1 A smaller, earlier trial by the same team in Los Angeles suggested that the two work better together than training alone.1
What the trial did
The trial took place at the University of California, Los Angeles (UCLA), in a clinic for people after a first episode of schizophrenia. It included 90 adults aged 18 to 45, on average 23, whose first episode had begun within the past 2 years. All took antipsychotic medicine and received regular care.1
For 6 months, everyone did computer-based cognitive training, 4 hours a week. Half were chosen at random to exercise as well. The other half attended a class on healthy living instead, so both groups spent the same time at the clinic.1
The exercise combined aerobic activity with strength training: two 45-minute group sessions a week, led by a fitness trainer, and two 30-minute sessions alone, adding up to about 150 minutes a week.1
Attention was measured with a computer test from the MATRICS Consensus Cognitive Battery, a standard set of thinking tests in schizophrenia research. Its scores are set so that the average in the general population is 50.3
What they found
At the start, attention scores averaged about 38. After 6 months, they had risen by 4.6 points in the exercise group and fallen by 0.2 in the comparison group. Overall thinking skills improved in both groups, by about 5 points, with no difference between them.1
People who came to more exercise sessions, and exercised harder, gained more in attention. That link suggests the exercise itself caused the improvement.1
The trial was small and took place at one centre. Halfway through, the COVID-19 pandemic moved the sessions online. Daily functioning improved in both groups alike, but lockdowns limited work and social life, so this was a weak test.1
A trial in Italy
From 2019 to 2021, seven mental health services in northern Italy randomly assigned 132 outpatients with schizophrenia to one of three groups for 15 weeks, each meeting twice a week:2
- a structured cognitive therapy in groups, called Integrated Neurocognitive Therapy
- exercise: a warm-up, 30 minutes on a treadmill or exercise bike at a steadily rising effort, and a cool-down
- usual care: art, music, cooking and social groups
The cognitive therapy improved planning and problem-solving, and thinking skills overall, compared with usual care. Exercise did not differ clearly from usual care. Symptoms and daily functioning did not differ between the three groups.2
The exercise in Italy was lighter than at UCLA: about 60 minutes of aerobic exercise a week, against about 150 minutes of exercise, and it came without cognitive training.1,2 Read together, the two trials suggest that exercise helps thinking most when it is regular and combined with cognitive training.
What we don’t know yet
- Whether the gains last after the programme ends.
- Whether it helps people who have been ill for many years, not only after a first episode.
- How much exercise is enough.
_MET_DT86.jpg){kind=link}