EXERCISE INTERVENTIONS FOR POSTURAL STABILITY IN PATIENTS WITH SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Abstract Background Patients with schizophrenia generally need long-term antipsychotic treatment for relapse prevention. On the other hand, antipsychotic drugs cause postural instability, resulting in an increased risk of falls. Therefore, potential interventions that could enhance postural stability have long been desired for this population. While exercise reportedly improves positive and negative symptoms, cardiopulmonary function, and cognitive functions in patients with schizophrenia, its impact on the postural sway remains unclear in schizophrenia. Aims & Objectives This systematic review and meta-analysis aimed to investigate whether exercise improves postural sway in schizophrenia. Method We conducted comprehensive literature searches in multiple electronic bibliographic databases using terms related to physical activity interventions, combined with keywords such as "schizophrenia," "exercise," and "postural sway" according to the PRISMA statement (RPOSPERO-ID: CRD42023425865). We included studies investigating the postural stability in patients aged 18 and over with schizophrenia who underwent any exercise intervention in addition to their pharmacotherapy. The primary outcome measure was the postural sway, as indicated by pre- and post-intervention scores. A standardized data collection tool extracted statistical information from the primary studies. For each included trial, treatment effects measured by continuous variables were calculated using standardized mean differences (SMD) along with 95% confidence intervals (CI) using EZR statistical software. We assessed the data for risk of bias, heterogeneity, reporting bias, and quality of evidence. Results Out of the 328 articles initially identified, a total of nine studies were selected for inclusion, involving 317 participants with a mean age of 46.3 years (including 151 men). There were five randomized controlled trials (55.6%), following two experimental studies (22.2%), a longitudinal study (11.1%) and one pilot study (11.1%). The duration of the intervention ranged from six weeks to 14 months, with sessions lasting 20 to 90 minutes (mean 56.1 minutes) and occurring 1 to 3 times per week. Most interventions incorporated body-mind interventions (55.6%), such as yoga therapy and Pilates. Despite the variation in evaluation methods, seven studies (77.8%) demonstrated a significant improvement in postural instability following each intervention. Meta-analysis of any exercise interventions revealed lack of significant improvement in postural sway (N=7, n=265, SMD=-0.19, 95% CI: -0.81 to 0.43, p=0.54, I2=78%, p<0.01). However, in a subgroup analysis, both yoga therapy (N=4, n=158, SMD=-0.42, 95% CI: -0.74 to -0.11, p=0.009, I2=0%, p=0.48) and Pilates (N=2, n=40, SMD=-0.81, 95% CI: -1.47 to -0.15, p=0.015, I2=1%, p=0.32) significantly improved the postural instability. In addition, each study exhibited ineligible bias in randomization, and the overall study quality was not high. Discussion & Conclusion While the meta-analysis of all exercise types combined found no significant improvements in postural sway, subgroup analyses focusing on Pilates and yoga therapy significantly enhanced postural stability. Exercises targeting core muscles and relaxation elements may reduce postural instability in schizophrenia. Since this review is limited by the scarcity of exercise types, further exercise interventions in addition to pharmacotherapy are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.031 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".