Sports Psychiatry

Head: Dr. med. Isabel Maurus

Description: “Mens sana in corpore sano" ("a healthy mind in a healthy body") is a Latin proverb that is still in line with current scientific findings. To date, there is ample evidence that regular physical activity has a positive effect on mental health and cognitive performance. These effects have also been shown for people with psychiatric illnesses such as schizophrenia. People with schizophrenia often suffer from persisting cognitive deficits and negative symptoms despite optimal pharmacological treatment. Additionally, individuals with schizophrenia consistently have higher morbidity and mortality than the general population, in part due to an increased risk for somatic comorbidities such as metabolic syndrome and cardiovascular diseases. In recent years, exercise has emerged as a possible new treatment option not only for the physical outcome of people with schizophrenia but also with regard to schizophrenia symptoms. However, many open questions remain about the neurobiological mechanisms responsible for the effects of aerobic endurance training. We currently conduct a multicentre, randomized, controlled clinical study that is the largest trial to date investigating the efficacy of aerobic endurance training in patients with schizophrenia. Using structural and functional magnetic resonance imaging, we explore the effects on global and regional cerebral volumes, white matter connectivity and the functional connectome. Moreover, we assess risk genes, genome-wide gene expression, epigenetics, and proteomics, including plasma levels of brain-derived neurotrophic factor and their influence on outcome parameters. Thereby, we want to enlarge our knowledge about the neuroplasticity processes of exercise to systematically establish a causal relationship between aerobic exercise, its neurobiological effects and outcome parameters.

Additionally, we will implement a discussion forum for exercise study partners, including clinician scientists, psychiatrists, psychologists, basic researchers, and representatives of patient, caregiver, and advocacy groups.

As a further project, we investigate motivational factors and barriers for healthy populations as well as people with mental illness to achieve a sufficient amount of physical activity to foster mental and physical health. In this context, we are particularly interested in the role of previous exercise history, personality-associated factors and reward experience after exercise.

In our outpatient clinic, we support professional athletes, who are usually exposed to extreme pressure, in promoting their mental health and take part in the scientific projects of the department of sports psychiatry of the DGPPN.

Main Areas of Interest:

- Neurobiological effects of exercise

- Somatic and clinical outcomes of exercise in people with mental disease

- Lifestyle interventions in severe mental illnesses

- Barriers and motivating factors towards regular physical activity

- Prevention, diagnosis and treatment of mental disease in professional athletes

Current projects:

- ESPRIT C3 exercise study

The BMBF funded ESPRIT C3 exercise study (research network Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments) is a multicenter, rater-blind, two-armed, parallel-group randomized clinical trial in patients with clinically stable schizophrenia being conducted at five German tertiary hospitals. The intervention group performs aerobic endurance training on bicycle ergometers three times per week for 40–50 min/session (depending on the intervention week) for a total of 26 weeks, and the control group performs balance and tone training for the same amount of time. Participants are subsequently followed up for 26 weeks. The primary endpoint is all-cause discontinuation; secondary endpoints include psychopathology, cognition, daily functioning, cardiovascular risk factors, and exploratory biological measures regarding the underlying mechanisms of exercise. A total of 180 patients could already be randomized. Our study is the largest trial to date to investigate endurance training in patients with schizophrenia. We hypothesize that aerobic endurance training has beneficial effects on patients’ mental and physical health, leading to lower treatment discontinuation rates and improving disease outcomes. The study results will provide a basis for recommending exercise interventions as an add-on therapy in patients with schizophrenia. The study is registered in the International Clinical Trials Database (ClinicalTrials.gov identifier [NCT number]: NCT03466112) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).

Publications:

1. Papiol S., Schmitt A., Maurus I, Rossner M., Schulze T., Falkai P. (2021). Association Between Physical Activity and Schizophrenia: Results of a 2-Sample Mendelian Randomization Analysis. JAMA Psychiatry. 78(4): p. 441-444.

2. Falkai P, Maurus I, Schmitt A, Malchow B, Schneider-Axmann T, Röll L, Papiol S, Wobrock T, Hasan A, and Keeser D (2021) Improvement in daily functioning after aerobic exercise training in schizophrenia is sustained after exercise cessation. Eur Arch Psychiatry Clin Neurosci 271: 1201-1203. 10.1007/s00406-021-01282-8

3. Maurus I, Hasan A, Roeh A, Keeser D, Malchow B, Keller-Varady K, Papazova I, Hirjak D, Topor C, Walter H, Mohnke S, Vogel B, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P (2020). Endurance training for the improvement of cognition and enhancement of recovery in schizophrenia: study design and methodology of a multicenter randomized, controlled trial. PRJ-2019-0285

4. Takahashi S, Keeser D, Rauchmann B-S, Schneider-Axmann T, Keller-Varady K, Maurus I, Dechent P, Wobrock T, Hasan A, and Schmitt A (2020) Effect of aerobic exercise on cortical thickness in patients with schizophrenia–a dataset. Data in Brief: 105517.

5. Maurus I, Hasan A, Röh A, Takahashi S, Rauchmann B, Keeser D, Schmitt A, Falkai, P. (2019): Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci, 269(5): 1-17.

6. Rauchmann BS, Ghaseminejad F, Keeser D, Keller-Varady K, Schneider-Axmann T, Takahashi S, Karali T, Helms G, Dechent P, Maurus I, Hasan A, Wobrock T, Ertl-Wagner B, Schmitt A, Malchow B, and Falkai P (2019) The impact of endurance training and table soccer on brain metabolites in schizophrenia. Brain Imaging Behav. 10.1007/s11682-019-00198-1

7. Maurus I, Röh A, Falkai P, Malchow B, Schmitt A, Hasan A. (2019): Nonpharmacological treatment of dyscognition in schizophrenia: effects of aerobic exercise. Dialogues In Clinical Neuroscience, 21(3): 261-269.

8. Maurus I, Mantel C, Keller-Varady K, Schmitt A, Lembeck M, Röh A, Papazova I, Falkai P, Schneider-Axmann T, Malchow B, Hasan A. (2019): Resistance training in patients with schizophrenia: Concept and proof of principle trial. J Psychiatr Res., 120(1): 72-82.

9. Takahashi S, Keeser D, Rauchmann S, Schneider-Axmann T, Keller-Varady K, Maurus I, Dechent P, Wobrock T, Hasan A, Schmitt A, Ertl-Wagner B, Malchow B, Falkai, P (2019): Effect of aerobic exercise combined with cognitive remediation on cortical thickness and prediction of social adaptation in patients with schizophrenia. Schizophr Res

10. Roeh A, Kirchner S, Malchow B, Maurus I, Schmitt A, Falkai P, Hasan A (2019). Depression in somatic disorders: is there a beneficial effect of exercise? Front Psychiatry, 10, 141. doi:10.3389/fpsyt.2019.00141.

11. Schmitt A, Maurus I, Rossner MJ, Roeh A, Lembeck M, von Wilmsdorff M, Takahashi S, Rauchmann B, Kesser D, Hasan A, Malchow B, Falkai P (2018): Effects of aerobic exercise on metabolic syndrome, cardiorespiratory fitness, and symptoms in schizophrenia include decreased mortality. Front Psychiatry, 9, 690. doi:10.3389/fpsyt.2018.00690

12. Schmitt A, Malchow B, Lembeck M, Maurus I, Roeh A, Papiol S,Hasan A, Falkai P. (2018). Bedeutung von Ausdauersport für die Verbesserung von Kognition und Remission bei post-akuter Schizophrenie. Nervenheilkunde, 37(05): 324-329.

13. Keller-Varady K, Varady PA, Roeh A, Schmitt A, Falkai P, Hasan A, and Malchow B (2018) A systematic review of trials investigating strength training in schizophrenia spectrum disorders. Schizophrenia research 192: 64-68.

14. Falkai P, Malchow B, and Schmitt A (2017) Aerobic exercise and its effects on cognition in schizophrenia. Curr Opin Psychiatry 30: 171-175. 10.1097/yco.0000000000000326

15. Malchow B, Keeser D, Keller K, Hasan A, Rauchmann BS, Kimura H, Schneider-Axmann T, Dechent P, Gruber O, Ertl-Wagner B, Honer WG, Hillmer-Vogel U, Schmitt A, Wobrock T, Niklas A, and Falkai P (2016) Effects of endurance training on brain structures in chronic schizophrenia patients and healthy controls. Schizophr Res 173: 182-191. 10.1016/j.schres.2015.01.005

16. Keller-Varady K, Hasan A, Schneider-Axmann T, Hillmer-Vogel U, Adomssent B, Wobrock T, Schmitt A, Niklas A, Falkai P, and Malchow B (2016) Endurance training in patients with schizophrenia and healthy controls: differences and similarities. Eur Arch Psychiatry Clin Neurosci 266: 461-73. 10.1007/s00406-015-0651-8

17. Malchow B, Keller K, Hasan A, Dorfler S, Schneider-Axmann T, Hillmer-Vogel U, Honer WG, Schulze TG, Niklas A, Wobrock T, Schmitt A, and Falkai P (2015) Effects of Endurance Training Combined With Cognitive Remediation on Everyday Functioning, Symptoms, and Cognition in Multiepisode Schizophrenia Patients. Schizophr Bull 41: 847-58. 10.1093/schbul/sbv020

Our Team:

- Prof. Dr. med. Peter Falkai

- Prof. Dr. med. Andrea Schmitt

- Dr. med. Isabel Maurus

- Lukas Röll, M.Sc, PhD student

- Dr. rer. biol. hum Dipl.- Psych. Daniel Keeser

- Dr. rer. nat. Sergi Papiol

- Sarah Wagner, M.Sc Psychologin

- David Greska, doctoral candidate

Collaborations:

- Klinik für Psychiatrie, Psychotherapie und Psychosomatik der Universität Augsburg

- ZI Mannheim

- RTWH Aachen

- Universitätsklinikum Düsseldorf

- Charité Berlin

- Präventive Sportmedizin und Sportkardiologie, TU München

- DGSPP

- DGPPN Referat Sportpsychiatrie