Ask an answerable question (PICO)：
To treat the mental symptoms of their condition, patients with schizophrenia are commonly prescribed antipsychotic and sedative medications. However, these drugs are often associated with cognitive dysfunction and gradual mental decline, including the inability to concentrate, loss of memory, and impeded decision-making and problem-solving abilities. To address this, mind-body exercises involving a range of physical activities such as yoga, tai chi and qigong emphasize a closer connection between the body, mind and emotions. Indeed, previous studies have reported on the cognitive benefits of mind-body exercises in older adults and subjects with cognitive impairments, with benefits including improved memory, attention and executive functions. Herein, we aimed to explore the benefits of mind-body exercises on cognitive functions in individuals with schizophrenia. The clinical question was Do mind-body exercises (Intervention) present benefits to cognitive functions (Outcome) in patients with schizophrenia (Patient)?
The Method and Analysis of Literature Review：
According to the 3A steps of empirical nursing, we conducted a search of literature published prior to December 2022 using the Cochrane Library, PubMed, Embase, CINAHL, Airiti Library, and the China Wanfang Database. The keywords were set according to PICO using the appropriate Bollinger logic. The inclusion criteria were: (1) systematic review or randomized controlled trial; (2) physical, mental, and spiritual exercise as interventions; and (3) cognitive function as outcome measure. A total of one systematic review and meta-analysis study (SR/MA) and one randomized controlled trial (RCT) were eligible for inclusion in the review.
Critical Appraisal：
According to the type of article, the CASP Systematic Review Checklist (2018) or the CASP Randomized Controlled Trial Standard Checklist (2020) were used as a review tool. The SR/MA met nine questions, with an evidence rating of 1++. The RCT met ten questions, with an evidence rating of 1-. The level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (2015), while the strength of the recommendation was estimated as B. The subjects of these two articles were with psychosis and >18 years of age, with yoga, tai chi and qigong exercises practiced 1-5 times per week at 45-60 minutes per session, for a total of 3-12 weeks. The SR/MA reported improvements in subjects’ positive symptoms, negative symptoms, quality of life, social functions, cognitive functions and depression. Additionally, the RCT reported improvements in subjects’ overall cognitive function, balance and task performance after 12 weeks of intervention.
Results, Conclusions and Recommendations：
The SR/MA revealed the effectiveness of mind-body exercises for improving positive symptoms, negative symptoms, depression and cognitive function in subjects with psychosis, indicating that the intervention helps treat psychosis. Meanwhile, the RCT found that after the intervention subjects exhibited improved overall cognitive function, with significant improvements in balance and task performance. Collectively, the studies indicate that patients with psychosis participating in mind-body exercises such as yoga, tai chi, and Baduanjin exercises, should be done more than 2 times per week at 45-60 minutes per session for 12 weeks, and exhibit improved overall cognitive functions. The mind-body exercises with psychomotor and posture movements are simple, cost-effective, and non-invasive interventions, with no side effects. Accordingly, we recommend that future studies combining a rigorous design and increased sample size be conducted to determine the optimal type and frequency of mind-body movements for enhancing the management of patients with psychosis in clinical practice.
