Randomised active controlled trial examining effects of aerobic exercise, cognitive and music interventions on depression, balance and mobility in schizophrenia

Schizophrenia significantly impairs daily functioning, requiring innovative, cost-effective treatments beyond standard antipsychotics, and cognitive interventions. This study examined the individual and combined effects of cognitive, music, and aerobic exercise interventions on depression, balance, and mobility in patients with schizophrenia and severe depression. Eighty-four male patients with schizophrenia and severe depression from an inpatient psychiatric centre participated in a 12-week, single-blind, randomised active-controlled trial. Participants were systematically assigned to one of seven equal groups (n = 12 each): aerobic exercise (AerG), cognitive rehabilitation/treatment-as-usual (CogG), music intervention (MusG), aerobic exercise + music intervention (A&MG), aerobic exercise + cognitive intervention (A&CG), cognitive intervention + music intervention (C&MG), and a comprehensive combination of all three modalities (ACMG). Each intervention was delivered over 60 min, three times weekly for 12 weeks. The study employed the Beck Depression Inventory Short Form, Stork Balance Test, and modified Timed Up and Go Test to assess improvements in depression, balance, and mobility. Statistical analyses were conducted using paired t-tests for within-group comparisons and ANCOVA with Bonferroni post hoc tests for between-group differences, with significance set at p ≤ 0.05. Results showed significant improvements in depression, balance, and mobility across all treatment groups. The CogG group outperformed both AerG and MusG in all outcomes, establishing it as the gold-standard comparator. A&CG yielded greater benefits than other single or dual-modality groups, while the multimodal ACMG group demonstrated the most substantial improvements across all measures. These findings highlight the practical value of incorporating multimodal interventions into standard care to improve both mental health and physical function, offering a scalable, cost-effective approach to addressing the diverse needs of this population of patients with schizophrenia and severe depression. Implementing such interventions in psychiatric care settings could lead to more comprehensive and effective treatment strategies for improving patient outcomes.