Exercise for the negative symptoms of schizophrenia: a review

Abstract

Negative symptoms of schizophrenia, comprising avolition, asociality, anhedonia, blunted affect, and alogia, are a primary driver of functional impairment, tend to persist, and have no treatment approved specifically for them. Exercise has drawn interest as a low-cost, widely available, adjunctive intervention. This review synthesizes three recent evidence syntheses: an umbrella review of previously published meta-analyses and two network meta-analyses of randomized controlled trials. All three report significant reductions in negative symptoms, with yoga consistently the most effective modality; aerobic and mind-body exercise also show benefit, while the evidence for resistance exercise is inconsistent across analyses. Reported effect sizes range from small to large, and this divergence appears to reflect differences in comparator group and analytic method rather than differences in study quality. A dose-response analysis estimated an optimal total dose of 1200 metabolic equivalent minutes per week but proved unstable under sensitivity analysis. Certainty of evidence was rated low to very low throughout. Two constraints recur across the literature: the rating scales used cannot distinguish primary from secondary negative symptoms, and avolition itself likely limits sustained participation in exercise. Exercise is a reasonable adjunctive intervention, but its specific benefit for primary negative symptoms remains poorly understood.