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The Awesome Power of Exercise

More Help for Schizophrenics--and the Rest of Us

Three months ago (March 2010) we explained how omega-3 fish oil kept young people with early signs of mental illness from progressing to full-blown schizophrenia: http://www.cbass.com/FishOil&Telomeres.htm.  Fish oil appears to have made their brain cells work and communicate better. Now, we have a study showing that aerobic exercise can significantly increase hippocampal volume in the brains of patients with schizophrenia—and in healthy controls. That’s good news for everyone. 

The hippocampus plays a major part in brain function. Damage to that region of the brain is known to cause memory problems and disorientation.

We’ve written extensively about the effect of exercise on brain function. It’s a fast emerging story about the awesome power of exercise. Exercise promotes brain plasticity; it helps generate and repair brain cells, and strengthen and build brain pathways. "Exercise is the single most powerful tool you have to optimize your brain function,” Harvard professor of psychiatry John J. Ratey wrote in his book SPARK: The Revolutionary New Science of Exercise and the Brain; for more details, see Reboot Your Brain with Exercise: http://www.cbass.com/RebootBrain.htm. (See also articles 139, 182, and 260 in our “Aerobic Exercise” category.)

Simply put, exercise makes the brain better able to cope with challenge.

As explained in the earlier article, schizophrenia is a mysterious disease characterized by gross distortion of reality. While the causes are not well understood, numerous abnormalities of brain structures have been reported. Many researchers have found reduced hippocampus size in schizophrenic subjects.

The authors of the new study, reported in the February 2010 issue of Archives of General Psychiatry, believe that reduced hippocampal volume in schizophrenia “may relate to an impairment of neural plasticity or mechanisms of reorganizing brain function in response to a challenge.”

The authors also observed that “exercise is a stimulus to hippocampal plasticity” in healthy individuals. Connecting the dots, they decided to use aerobic exercise to “probe into the capacity of the hippocampus for plasticity in schizophrenia.” Happily, they found that plasticity is present.

“The therapeutic options for schizophrenia are not really good, and we’re convinced that schizophrenia is a brain disease [characterized by] a lack of neuroplasticity,” said lead researcher Frank-Gerald Pajonk, MD, Department of Psychiatry and Psychotherapy, The Saarland University Hospital, Homburg, Germany. “So we wanted to look at solutions that could possibly improve this deficit.”

“These results indicate that in [these patients], hippocampal volume is plastic in response to aerobic exercise,” wrote Dr. Pajonk and his colleagues.

“To our knowledge, this is the first time that it has been shown that the hippocampus is growing in patients with schizophrenia," Dr. Pajonk told Medscape Psychiatry.

“As the hippocampus is one of the core structures in schizophrenia, we were thinking that if there was an increase in volume, it could give some improvement in cognition," Pajonk added. "And that’s what we found.”

The details are interesting and encouraging—for all of us.

Study Details and Results

The study included 16 adult males with chronic schizophrenia and eight matched healthy controls. Those with schizophrenia were randomly assigned to an exercise program consisting of 30 minutes of supervised cycling three times a week for three months, or to play tabletop football for the same amount of time. One half of the patients cycled and the other half played tabletop football. All eight healthy controls took part in the cycling program.

All participants underwent magnetic resonance imaging (MRI) of the hippocampus, as well as neuropsychological and clinical testing. In addition, all subjects were tested for aerobic fitness.

Interestingly, hippocampal volume was 4% smaller in the schizophrenic patients before exercise training.

Hippocampal volume increased in all participant who cycled, by 12% in those with schizophrenia and 16% in the healthy controls; there was no change in those who played tabletop football.

Significantly, changes in hippocampal volume were correlated with improvement in aerobic fitness.

“To provide a context,” the authors wrote, “the magnitude of these changes in volume was similar to that observed for other [deep brain] structures when patients were switched from typical to atypical antipsychotic drug therapy.” Exercise apparently had effects similar to potent drugs, without the possible side effects.

Short-term memory scores also improved. The patients in the schizophrenia exercise group showed a 34% improvement in short-term memory after the exercise program, while schizophrenia patients who did not exercise scored 6% lower. Tellingly, for the combined exercise and non-exercise schizophrenia group, changes in short-term memory were correlated with change in hippocampal volume. In short, increase in volume went hand in hand with improved memory.

In the schizophrenia exercise group—but not in the healthy controls—change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate, “a marker of neuronal [brain cell] integrity.” The authors are not sure what this means, but it could suggest that the brains cells of the schizophrenia patients were more in need of repair or renewal. 

Finally, the severity of total symptoms of schizophrenia improved somewhat in the exercise group--9% lower--and worsened in the non-exercise group--13% higher. 

“In summary,” the authors wrote, “the present study indicates that the hippocampus in schizophrenia retains a degree of plasticity, at least to a specific challenge such as exercise.”  

Exercise works.

Wider Implications

“Although I can’t prove it right now, I’m positive that exercise is doing good in the treatment of schizophrenia,” Dr. Pajonk opined enthusiastically. “Many of the schizophrenia patients from the [cycling] groups were able to go on and develop a life of their own, moving to a new apartment, taking up a job again, etc. It’s a bit early and we just had a small sample size, but with this small number of patients, we were really surprised and amazed at what has happened to them.”

Christopher A. Ross, MD, PhD, director of the Division of Neurobiology and professor of psychiatry at Johns Hopkins School of Medicine, who did not take part, called the study “interesting” with implications beyond schizophrenia. “In a sense, this was more a study about the brain and plasticity than schizophrenia per se,” he told Medscape Psychiatry. “The good news is that the brain is much more plastic than we had previously appreciated,” he continued. “Just something like exercising may alter a significant feature of brain structure.”

As noted at the beginning, this study and others show the awesome power of exercise to improve brain function.

We must not forget, however, that “use it or lose it” still applies. Dr. Pajonk clearly suggests that many of the patients who exercised used their new and improved brain volume to make a better life for themselves.

Exercise alone won’t make anyone “a genius,” Dr. Ratey related in his book Spark. “With learning, you have to respond to something in a different way. But something has to be there.” Exercise creates an environment conducive to change, but you must give your brain a new challenge.

The schizophrenia patients responded to their challenge in ways they were unable to without exercise. The rest of us need to do the same. We must exercise our body and challenge our brain.

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