Efficacy of Baduanjin Versus Brisk Walking on Cognitive and Physical Functions in Schizophrenia: A Three-Arm Randomized Controlled Trial

Abstract

Highlights: What are the main findings? Baduanjin and brisk walking improved both cognition and physical fitness in patients with schizophrenia. Baduanjin showed higher gains in verbal memory, executive function, balance, and dual-task performance, which were maintained after the intervention. What are the implications of the main findings? Baduanjin can serve as an accessible mindful exercise to enhance recovery in schizophrenia. Physical exercise is beneficial for psychiatric rehabilitation in schizophrenia. Background: Cognitive and physical deficits are core features of schizophrenia. Although Baduanjin and brisk walking (BW) have shown promise as intervention strategies, comparative evidence with follow-up and considering maintenance is limited. Objective: This study compared the effects of Baduanjin, BW, and health education (HE) on cognitive and physical outcomes in schizophrenia and examined whether a maintenance program could sustain these effects. Methods: In this single-blind three-arm randomized controlled trial, 60 patients with schizophrenia were assigned to Baduanjin (n = 20), BW (n = 20), or HE (n = 20). Interventions were conducted three times weekly for 12 weeks, each lasting 60 min, followed by a four-week home-based maintenance program with brochures and short message reminders. Cognitive outcomes were assessed using the Brief Assessment of Cognition in Schizophrenia, and physical outcomes included the Six-Minute Walk Test (6MWT), 30-Second Chair Stand Test (30CST), Timed Up-and-Go (TUG), motor dual-task TUG (TUGmanual), and cognitive dual-task TUG (TUGcognitive). Results: Baduanjin produced larger improvements than HE in verbal memory, attention and processing speed, executive function, and global cognition. BW significantly enhanced the working memory and global cognition versus HE, with additional improvements in attention and processing speed at follow-up. Both Baduanjin and BW improved the walking distance and lower-limb strength compared with HE, while Baduanjin outperformed BW and HE in balance and dual-task outcomes. Conclusions: Baduanjin and BW improved cognitive and physical functions in individuals with schizophrenia. Maintenance programs with short message reminders may help sustain these benefits.