interval training in standard treatment of out-patients with schizophrenia: a randomized controlled trial Objective: To evaluate the feasibility and effects of integrating aerobic interval training (AIT) in standard care of out-patients with schizophrenia on aerobic capacity and conventional cardiovascular disease (CVD) risk factors. Methods: Out-patients with schizophrenia spectrum disorder were randomized to the following: 1) a training group (TG), performing AIT 2 day/week at the clinic with adherence support from municipal services; or 2) a control group (CG), given two AIT sessions and encouraged to exercise on their own. Feasibility was assessed through retention/adherence. _ VO 2peak was measured directly along with conventional CVD risk factors before and after 12 weeks. Results: Of 48 out-patients, 16/25 and 18/23 completed the TG and CG respectively. After 12 weeks, _ VO 2peak was higher (2.7 AE 4.8 ml/kg/min, P < 0.01) in the TG compared with the CG. The TG improved _ VO 2peak by 3.1 AE 3.7 ml/kg/min (P < 0.01), while no change in the CG was observed. No intergroup difference in weight, body mass index (BMI), waist circumference, blood pressure, lipids, or glucose at posttest was observed. Weight (1.9 AE 4.0 kg, P < 0.05) and BMI (0.5 AE 1.1 kg/m 2 , P < 0.05) increased in the CG, with no change in the TG. Conclusion: AIT, combined with adherence support, of out-patients with schizophrenia was feasible, improved _ VO 2peak , and may be integrated in standard care. (ClinicalTrials.gov identifier: NCT02743143). Significant Outcomes• Adherence-supported aerobic interval training, integrated as standard care, improved aerobic capacity in out-patients with schizophrenia within 12 weeks. Peak oxygen uptake was measured directly along with conventional CVD risk factors.• A short introduction to aerobic interval training consisting of two training sessions and advise to continue physical training did not improve aerobic capacity. Limitations• This study was a single-center randomized controlled trial, suggesting external validity (generalizability) may be limited.• Our assessment of feasibility and effects are based on data before and after 12 weeks, and the longterm effects of the treatment are thus unclear.

Patients with schizophrenia have impaired physical health. However, evidence of how skeletal muscle force‐generating capacity (FGC), a key component of functional performance, may contribute to the impairment is scarce. Thus, the aim of this study was to investigate the patient groups’ skeletal muscle FGC and its association with functional performance. Leg‐press FGC was assessed along with a battery of functional performance tests in 48 outpatients (28 men, 34 ± 10 years; 20 women, 36 ± 12 years) with schizophrenia spectrum disorder (ICD‐10, F20‐29), and compared with 48 healthy age‐ and gender‐matched references. Results revealed reduced one‐repetition maximum (1RM) in men (−19%, P < .01) and a trend toward reduction in women (−13%, P = .067). The ability to develop force rapidly was also impaired (men: −30%; women: −25%, both P < .01). Patients scored worse than healthy references on all physical performance tests (stair climbing: −63%; 30‐second sit‐to‐stand (30sSTS): −48%; six‐minute walk test (6MWT): −22%; walking efficiency: −14%; and unipedal stance eyes open: −20% and closed: −73%, all P < .01). 1RM correlated with 6MWT (r = .45), stair climbing (r = −.44), 30sSTS (r = .43), walking efficiency (r = .26), and stance eyes open (r = .33) and closed (r = .45), all P < .01. Rapid force development correlated with 6MWT (r = .54), stair climbing (r = −.49), 30sSTS (r = .45), walking efficiency (r = .26), and stance eyes open (r = .44) and closed (r = .51), all P < .01. In conclusion, skeletal muscle FGC and functional performance are reduced in patients with schizophrenia and should be recognized as important aspects of the patient groups’ impaired health. Resistance training aiming to improve these components should be considered an important part of clinical treatment.

Patients with schizophrenia are physically inactive and have high prevalence of cardiovascular disease (CVD). Peak oxygen uptake (V̇O2peak) is one of the strongest predictors for CVD, yet is rarely investigated in this patient population, and how V̇O2peak relates to other conventional CVD risk measures in this population is unclear. We measured treadmill V̇O2peak along with daily physical activity assessed by triaxial accelerometry, body mass index (BMI), waist circumference, blood pressure, lipid profiles, and glucose in 48 outpatients (28 men, 35 ± 10 (SD) years; 20 women, 35 ± 12 years), diagnosed with schizophrenia, schizotypal, or delusional disorders (ICD‐10; F20‐29). The patients were compared with 48 age‐ and sex‐matched healthy references (±2 years) and normative data from the population. V̇O2peak was 34.5 ± 8.7 mL/kg/min (men) and 26.4 ± 7.0 mL/kg/min (women), which was 27% and 30% lower than healthy references, respectively (both P < 0.01). V̇O2peak was not associated with daily physical activity in men while a weak association was seen in women (steps per day: r2 = 0.26; counts per minute: r2 = 0.25; P < 0.05). BMI (26.0 ± 6.1 kg/m2) revealed that patients were moderately overweight with a waist circumference of 103 ± 17 cm. Lipid‐ and glucose levels, and blood pressure were all within normative range. Our data advocate the utilization of V̇O2peak assessment for CVD risk profile determination in patients with schizophrenia. Daily physical activity was poorly and inconsistently related to V̇O2peak, suggesting increased daily physical activity might not translate into improved V̇O2peak and CVD risk reduction.

Dam Foundation; The Liaison Committee for education, research and innovation in Central Norway Although aerobic interval training (AIT) is recognized to attenuate the risk of cardiovascular disease (CVD) and premature mortality, it appears that it rarely arrives at patients' doorsteps. Thus, this study investigated 1-year effects and feasibility of AIT delivered with adherence support in collaborative care of outpatients with schizophrenia. Forty-eight outpatients (28 men, 35 [31-38] (mean [95% confidence intervals]) years; 20 women, 36 [30-41] years) with schizophrenia spectrum disorders (ICD-10) were randomized to either a collaborative care group provided with municipal transportation service and training supervision (walking/running 4 × 4 minutes at ~90% of peak heart rate; HR peak) 2 d wk −1 at the clinic (TG) or a control group (CG) given 2 introductory AIT sessions and advised to continue training. Directly assessed peak oxygen uptake (VO 2peak) increased in the TG after 3 months (2.3 [0.6-4.4] mL kg −1 min −1 , Cohen's d = 0.33[−4.63 to 4.30], P = 0.04), 6 months (2.7 [0.5-4.8] mL kg −1 min −1 , Cohen's d = 0.42[−4.73 to 4.11], P = 0.02) and 1 year (4.6 [2.3-6.8] mL kg −1 min −1 , Cohen's d = 0.70[−4.31 to 4.10], P < 0.001) compared to the CG. One-year cardiac effects revealed higher HR peak (7 [2-11] b min −1 , Cohen's d = 0.34[−8.48 to 8.65], P = 0.01), while peak stroke volume tended to be higher (0.9 [−0.2 to 2.0] mL b −1 , Cohen's d = 0.35[−1.62 to 2.