A rapid review of walking interventions in people with schizophrenia and schizophrenia spectrum disorders

Objective
People with severe mental illness are less physically active than healthy controls, contributing to poorer physical
health outcomes. Walking has been recommended as one of the simplest ways of increasing physical activity
in this population (McDonough et al., 2021). The last systematic review of walking interventions for people
with schizophrenia spectrum disorders was conducted nearly a decade ago (Soundy et al., 2014). This review
showed that walking was safe, with some evidence for weight reduction, but broader benefits were yet to be
established. This rapid review therefore aims to update the previous review and synthesise recent evidence
on the effectiveness of walking interventions on levels of physical activity, quality of life and symptomology in
people with schizophrenia spectrum disorders.
Method
The protocol for this review was developed a priori according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines. As this is a rapid review, the review process was accelerated
by searching a single database and data extraction by a single person. The PubMed (advanced) database was
searched, using a predefined search strategy based on Soundy et al. 2014, on 5/1/22 using the search terms “exercise” OR “physical activity” OR “walking” OR “lifestyle” OR “pedometer” AND “schizo*”. These results were
filtered to include papers from 1/1/2014 – 5/1/22 to capture studies published since the previous review. Eligible
studies included participants with a diagnosis of schizophrenia or a schizophrenia spectrum disorder, included
walking as an intervention component, and included physical activity (subjective or objective) as an outcome
measure. Two reviewers independently screened titles and abstracts using the Rayan systematic review software. Conflicts were decided by an independent verifier.The same dual screening process was followed for full
texts. Study details and data were extracted using a customised form, piloted prior to use. The risk of bias was
determined using the Cochrane risk of bias tool. At the date of abstract submission, data analysis for physical
activity, and other relevant outcomes is in progress. Where appropriate, data will be pooled via meta-analysis.
Alternatively, data will be qualitatively synthesised using van Tulder levels of evidence.
Results
The updated search identified nine eligible studies (four RCTs and five single group pre-post studies) with a total
of 929 participants. The walking interventions were conducted over 8-12 weeks and the walking component
varied e.g. weekly supervised group walks, brisk walking as part of a supervised exercise class, unsupervised
wearable-based walking (pedometers, fitbits) supported by behaviour change elements such as step goals and
monitoring. The risk of bias of all studies included in this review was low. Outcomes related to physical activity,
quality of life and symptomology will be presented at the conference.
Conclusion
There has been an increase in the number of RCTs published since the last systematic review and the methodological quality of studies in this area has improved. This should provide more robust evidence to guide research
and practice in this important area.