Comparison of the Effects of Physical Activity and Virtual Reality Training in Patients With Schizophrenia

Comparison of the Effects of Physical Activity and Virtual Reality Training on Physical Function, Cognition and Quality of Life in Patients With Schizophrenia

The current study aims to compare the effects of physical activity and Virtual Reality training on physical function, cognition and quality of life in patients with Schizophrenia.

It is hypothesized in the literature that both physical activity and VR may have positive effects on the symptoms of PwS. Still, which modality may be more effective has yet to be discovered. By comparing the effects of physical activity and VR training on the symptoms of PwS, this study may provide valuable insights into the potential benefits of these interventions and inform the development of effective treatment strategies for PwS.

Our study will discuss this relationship, and the results will be presented.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Cognitive Impairment; Balance; Distorted
• Intervention / Treatment: Device: Virtual Reality (VR); Other: Physical Activity (PA group); Other: occupational therapy

Detailed Description

1 INTRODUCTION AND PURPOSE

Schizophrenia is a debilitating mental disorder characterized by disruptions in thinking, perception, emotions, and social functioning (1). Patients with schizophrenia (PwS) often experience impairments in physical function, cognition, and quality of life, which can significantly impact their overall well-being. As part of the pursuit to enhance treatment outcomes, researchers, including physical therapists, have explored various adjunctive therapies that can potentially alleviate these impairments. In this study, we aim to compare the effects of physical activity (PA) and virtual reality (VR) training on physical function, cognition, and quality of life in Patients with schizophrenia (PwS), compared to a control group that undergoes regular occupational therapy.

1.1 Background Physical activity has been recognized as a beneficial intervention for individuals with mental disorders, including schizophrenia (2). Engaging in regular physical activity has been associated with improved physical fitness, cardiovascular health, and muscle strength. Furthermore, studies have shown that physical activity can positively influence cognitive function, including attention, memory, and executive functions, in individuals with schizophrenia (2, 3). These improvements in physical and cognitive domains can potentially lead to enhanced quality of life for these individuals.

Virtual reality training, on the other hand, is an emerging therapeutic approach that provides immersive and interactive experiences through computer-generated simulations. While the benefits of physical activity have been extensively studied in schizophrenia, research investigating the specific effects of virtual reality training in this population is limited (4). There is a need to explore the potential benefits of VR in improving physical function, cognition, and quality of life in individuals with schizophrenia to expand our understanding of its therapeutic value.

1.2 Significance Understanding the comparative effects of physical activity and virtual reality training on physical function, cognition, and quality of life in Patients with schizophrenia (PwS), in comparison to the control group undergoing regular occupational therapy, holds significant importance. By comparing these interventions, we can identify their relative effectiveness and potential benefits in addressing the impairments associated with schizophrenia. This knowledge can inform clinicians, researchers, and healthcare professionals, including physical therapists, in making evidence-based decisions regarding the use of these interventions in clinical practice. Additionally, it may contribute to the development of personalized treatment approaches that optimize outcomes and improve the overall well-being of individuals with schizophrenia.

1.3 Overview This study describes a comparative analysis of three groups: a physical activity intervention group, a virtual reality training intervention group, and a control group that undergoes regular occupational therapy at the center. The study will recruit a sample of individuals diagnosed with schizophrenia and randomly assign them to one of the three groups. Assessments of physical function, cognitive performance, and quality of life will be conducted before and after the interventions to evaluate the effectiveness of each approach. The findings of this study will contribute to the existing literature and inform the development of evidence-based interventions for individuals with schizophrenia, particularly in the context of physical therapy.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Kartal Dr Lutfi Kirdar City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Between the ages of 20 and 77 years old.
• Willing to participate in research.
• Diagnosed with Schizophrenia according to the criteria defined in the DSM-IV by a psychiatrist.
• Able to attend Community Mental Health Center regularly.
• Not diagnosed with a mental disability, alcoholism, or drug addiction.
• Scoring 40 points or higher on the GAF test, indicating a non-severe mental state.
• Capable of fully understanding the purpose and content of the research.
• Able to participate in physical activity that requires musculoskeletal movement without difficulty, as determined by self-report.

Exclusion Criteria:

• Have significant cardiovascular, neuromuscular, endocrine, or other disorders that might prevent safe participation in the study.
• Have a diagnosis of alcohol or substance abuse.
• Have a secondary diagnosis of neurological disease or disease associated with the consumption of toxins, addiction to technology, or compulsive gambling.
• Unable to read, understand, or respond to assessment tests.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Physical Activity (PA group); The program will be comprised of (5 minutes) Warm-up (5 minutes) Strengthening exercises (Lunges- squats) (10 minutes) Balance and Cardiovascular endurance (HIIT-penguin seesaw- table tilt) (15 minutes) Aerobic ex (stationary bike- dancing) (5 minutes) Cool down exercises and breathing control. In addition to all these, the individuals will continue occupational therapy.	Device: Virtual Reality (VR); Participants will engage in the VR gaming intervention three times a week for 12 weeks. Each session will last approximately 45 minutes, providing ample gameplay, instruction, and debriefing time.
Active Comparator: Virtual Reality (VR) group; Group 2 Virtual Reality (VR) group will undergo 45 minutes of the Nintendo Wii-FitTM game. First of all, it will start with games that include warm-up exercises ( 5 min) and then continue with games that include strengthening (5 min), balance (5 min) and aerobic exercises (15 min). Finally, the treatment will be terminated with games, including cool-down (5 min) exercises. In addition to all these, the individuals will continue occupational therapy.	Other: Physical Activity (PA group); The intervention includes a 5-minute warm-up, 10 minutes of strengthening exercises (lunges and squats), 20 minutes of balance and cardiovascular endurance activities (HIIT exercises), 20 minutes of aerobic exercises (stationary bike and dancing), and a 5-minute cool-down with breathing control. Participants also continue with personalized occupational therapy to enhance their functional abilities.
Sham Comparator: control group; This group will undergo regular occupational therapy at the treatment center	Other: occupational therapy; the group will undergo their normal occupational therapy activities that include drawing, coloring, mathematical problems as well as solving mazes

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Simple Physical Activity Questionnaire	The SIMPAQ is a five-point evaluation tool designed to assess physical activity and sedentary behavior in individuals with common mental disorders.	12 weeks
Six minute walking test	The 6-Minute Walk Test (6MWT) is a standardized physical performance test that measures the distance an individual can walk on a flat, hard surface in six minutes. It provides an objective assessment of functional exercise capacity, endurance, and overall mobility in daily life activities.	12 weeks
The Mini-Mental State Examination	The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to assess cognitive function and detect cognitive impairments. While the MMSE is not specifically designed to evaluate cognitive deficits associated with schizophrenia, it can still provide some insights into general cognitive functioning in individuals with schizophrenia. In schizophrenia, cognitive impairments are frequently observed across various cognitive domains, including attention, working memory, executive function, verbal fluency, and processing speed. These cognitive deficits can significantly impact daily functioning, quality of life, and overall outcomes for individuals with schizophrenia.	12 weeks
SF-36	It is a widely used self-report questionnaire that assesses health-related quality of life (HRQoL)	12 weeks
Berg Balance Scale	Berg Balance Scale (BBS) is a standardized clinical test used to evaluate static and dynamic balance. It consists of 14 functional tasks, such as standing, reaching, and turning, each scored on a 5-point scale. The total score provides an objective measure of balance performance and fall risk in individuals.	12 weeks
Time Up and Go Test	The Timed Up and Go Test (TUG) is a standardized assessment that measures functional mobility. Participants are asked to stand up from a seated position, walk three meters, turn around, walk back, and sit down. The time taken to complete the task is recorded, providing an objective measure of mobility, balance, walking ability, and fall risk	12 weeks
Sit to Stand test	"The Sit-to-Stand Test is a functional performance measure used to assess lower limb strength, endurance, and mobility. Participants are asked to rise from a seated position to a full stand and return to sitting, repeated either for a set number of repetitions (e.g., five times) or within a fixed time period (e.g., 30 seconds). The total time or number of repetitions provides an objective indicator of lower body function and fall risk.	12 weeks
Grip strength	he Grip Strength Test is a standardized assessment of hand and forearm muscle strength. Participants are instructed to squeeze a calibrated hand dynamometer with maximum effort, usually in a seated position with the elbow at 90 degrees. The highest value from repeated trials is recorded, providing an objective measure of upper extremity strength and overall functional capacity	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Calgary Depression Scale	The Calgary Depression Scale was developed by Addington et al. (1994) as a tool to measure the presence and severity of depressive symptoms in patients with schizophrenia.	12 weeks
Katz Activities of Daily Living Scale	The Katz Index of Independence in ADLs (Katz Index) is a widely used tool to assess basic activities of daily living (ADLs) such as bathing, dressing, toileting, transferring, continence, and feeding.	12 weeks
Lawton Brody Instrumental Activities of Daily Living Scale	IADL is a commonly used tool to assess the level of independence in instrumental activities of daily living in older adults.	12 weeks

Collaborators and Investigators

• Sponsor: Yeditepe University

Study record dates

Study Major Dates

• Study Start (Actual): May 26, 2023
• Primary Completion (Actual): July 2, 2023
• Study Completion (Actual): August 2, 2023

Study Registration Dates

• First Submitted: May 25, 2023
• First Submitted That Met QC Criteria: September 12, 2025
• First Posted (Estimated): September 15, 2025

Study Record Updates

• Last Update Posted (Estimated): September 15, 2025
• Last Update Submitted That Met QC Criteria: September 12, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: schizophrenia; Cognition; Virtual reality
• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Schizophrenia; Cognitive Dysfunction; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Patient Care; Rehabilitation; Aftercare; Continuity of Patient Care; Exercise; Occupational Therapy
• Other Study ID Numbers: 64-2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No