For many people living with a schizophrenia spectrum diagnosis – whether in an inpatient setting or in the community – everyday tasks can seem difficult. Activities such as standing from a chair and walking between rooms may become more difficult due to medication side effects, poor physical health, or reduced cardiovascular fitness (Firth et al., 2019). Research shows that people with psychosis engage less in exercise, which in turn may contribute to poor physical health outcomes (Vancampfort et al., 2017).
Exercise is increasingly being promoted as an important component of good mental health care (Solmi et al., 2025). Previously we have featured blogs here showing that high intensity interval training (HIIT) training is supported by psychiatric patients and that group exercise interventions need to be supported and encouraged by individualized approaches in this group. However, there remains a lack of research on the effectiveness of exercise interventions for people with severe and recurrent mental health problems.
Broadly speaking, exercise falls into two categories:
- Aerobic activities (cardio exercises such as running and cycling) and
- Anaerobic activities (resistance training with heavy weights).
Although the benefits of anaerobic activity are well documented for both physical and mental health, its use in inpatient services has been limited by perceptions regarding feasibility, patient capabilities and safety.
To address these assumptions and generate formal data, a Feasibility The randomized controlled trial was led by Korman and colleagues (2025). The study was conducted in psychiatric rehabilitation wards Structured anaerobes compared Resistance training with aerobic interval training in people with mental disorders.. He focused on whether this type of training could be safelyDid the participants get it acceptableAnd what was the overall approach possible In patient settings.
Anaerobic exercise interventions have been limited in inpatient settings due to a lack of evidence on feasibility and safety.
methods
This was a pragmatic, single-blind (participants aware of their allocation), two-arm randomized controlled feasibility trial conducted in three psychiatric residential rehabilitation units in Australia. No a priori hypothesis was proposed. Participants were randomized 1:1 to resistance training or aerobic interval training. The main purpose as a feasibility study was to help researchers decide whether to proceed, modify, or abandon further study.
A pragmatic single-blind, two-arm randomized controlled feasibility trial was conducted.
Result
Fifty-four participants were recruited who were 71% male and had an average of three chronic illnesses in addition to psychosis. Representing 71% of those initially referred.
Reasons for non-participation included changes in community (n=7) and decreasing participation (n=13). Randomization of exercise type did not affect participation.
The primary results were:
- Feasibility – In both groups, 88.8% of participants were considered adherent to the intervention.
- Acceptability – Self-report questionnaire based on the theory of student acceptability.
- Safety – Three serious adverse events (1 in resistance training, 2 in aerobic interval training) were reported, and none were exercise-related.
conclusion
The authors say resistance training appears to Both feasible and safe within psychiatric rehabilitation settings Patients on the schizophrenia spectrum are diagnosed with chronic illnesses and live with high body weight.
The authors concluded:
Resistance training was feasible and acceptable for people with mental disorders, with no serious adverse events and was equivalent to aerobic interval training.
Resistance training was possible and acceptable for people with mental disorders.
Strengths and limitations
A major strength of the study was that Well-designed adverse event protocolWho actively anticipated delayed onset muscle soreness (DOMS) – an expected response to resistance training, but one that can feel extremely unpleasant, especially if you’re not expecting it. this level of detail Supports secure delivery and provides a useful model for implementation. Importantly, the authors noted that while three participants needed to reschedule a session due to DOMS, none withdrew from the program, reassuring readers that the protocol was both safe and manageable.
Although the findings are encouraging, the study is subject to several important limitations. As a feasibility test, the study Was not powered to detect differences in physical health outcomesAnd the authors do not reasonably claim otherwise. In the early stage, the absence of a non-exercise control group makes it more Difficult to draw conclusions about potential effectiveness. However, the authors note the practical challenges of including a control group in settings where participants are living together, noting that there would be a high likelihood of “contamination”.
Another thing to note is that this trial was affected by the COVID-19 pandemic, which disrupted deliveries and practices. Although the study reported a participation rate of more than 70% at 8 weeks, the prospective trial registration did not clearly specify the feasibility threshold in advance, leading the authors to rely on benchmarks from similar research. This limits transparency about whether feasibility criteria were defined a priori or interpreted retrospectively. However, it still suggests that at least people in rehabilitation wards who are not already active can and want to exercise.
Additionally, while it is important not to overburden participants, it is less clear what impact this research had on participants beyond fitness changes – for example, whether there was any impact on mental health, motivation, self-confidence, daily functioning. The prospective study noted that a qualitative component was planned and would have provided valuable insight into how participants experienced the program, what they found useful and/or challenging, and the impact it may have had that would not have been captured through physical health measures. It’s possible that COVID-19 has made this unviable, but it leaves a significant gap. Understanding the experiences of people who participated in this program would add depth to the findings and strengthened the findings regarding real-world implications.
The study included a well-designed adverse event protocol, which prospectively assessed delayed onset muscle soreness (DOMS).
Implications for practice
Despite the limitations, this study provides an exciting and important insight: Resistance training can be delivered safely and acceptably in inpatient rehabilitation settings.Demonstration of actual feasibility. search it directly Challenges long-held beliefs About what is possible when improving the physical health of people with schizophrenia.
This study therefore creates a clear roadmap for “what comes next”. Future efficacy trials – perhaps using a cluster-controlled methodology to minimize “contamination” between study arms – seem necessary. With this foundational work, Research can begin to expand and develop physical health interventions that are not only evidence-based, but realistic, respectful, and accessible For people living in inpatient mental health services. This project makes one thing undeniably clear: Better physical health care in inpatient mental health settings is not a distant goal, it is an achievable reality..
Better physical health care in inpatient mental health settings is not a distant goal.
Statement of Interests
An SA is a person suffering from schizophrenia who is frustrated by the lack of exercise opportunities available to patients (including himself) while receiving inpatient treatment. BM is a hyrox queen!
SA and BM used Microsoft Co-Pilot to assist with grammar and sentence structure in developing this blog.
edited by
Simon Bradstreet.
Link
primary paper
Nicole Korman, Robert Stanton, Mike Trott, Brendan Stubbs, Andrea Baker, Cassandra Butler, Dan Siskind, Simon Rosenbaum, Joseph Firth, Rebecca Martland, Talia McIntosh, Nicola Warren, Edward Heffernan, Francis Dark, Justin Chapman. (2025). Feasibility of aerobic exercise versus resistance training in a rehabilitation setting for people with mental disorders: a randomized controlled trial. Aust NZJ Psychiatry.
Other references
Firth, J., Siddiqui, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allen, S., Caneo, C., Carney, R., Carvalho, AF, Chatterton, M., Correll, CU, Curtis, J., Gaughran, F., Heald, A., Hoare, E., Jackson, S., Kisly, S., Lovell, K.,… Thorncroft, G. (2019). The Lancet Psychiatry Commission: A blueprint for protecting physical health in people with mental illness. Lancet Psychiatry6(19), 1-39.
Solmi, M., Basadona, I., Bodini, L., Rosenbaum, S., Schuch, FB, Smith, L., Stubbs, B., Firth, J., Vancampfort, D., and Ashdown-Franks, G. (2025). Exercise as a transdiagnostic intervention to improve mental health: a comprehensive review.. Psychiatry Research Journal. 184:91.
Vancampfort, D., Firth, J., Schuch, F.B., Rosenbaum, S., Mugisha, J., Hallgren, M., Probst, M., Ward, P.B., Gaugran, F., and de Hert, M. (2017). Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis.. world psychiatry16(3), 308-315.
