For many people living with a schizophrenia spectrum diagnosis – whether in inpatient settings or in the community – everyday tasks can feel hard. Activities such as standing up from a chair and moving between rooms can be made more difficult by medication side effects, poor physical health or low cardiovascular fitness (Firth et al., 2019). Research shows people with psychosis tend to engage less in exercise, which may in turn contribute to worse physical health outcomes (Vancampfort et al., 2017).
Exercise is increasingly promoted as an important component of good mental health care (Solmi et al., 2025). Previously we have featured blogs here showing that High Intensity Interval Training (HIIT) training has been endorsed by psychiatric inpatients and that group exercise interventions need to be supported and encouraged in this group by an individualised approach. However, there remains a lack of research on the effectiveness of exercise interventions for people with serious and recurring mental health problems.
Broadly, exercise falls into two categories:
- aerobic activities (cardio exercises like running and cycling) and
- anaerobic activities (resistance training with heavy weights).
Although the benefits of anaerobic activity are well documented for both physical and mental health, its use in inpatient services has been limited by assumptions regarding feasibility, patient capabilities and safety.
To address these assumptions and generate formal data, a feasibility randomised controlled trial was led by Korman and colleagues (2025). Conducted in psychiatric rehabilitation wards, the study compared structured anaerobic resistance training with aerobic interval training in people living with psychotic disorders. They focused on whether this type of training could be delivered safely, whether participants found it acceptable, and whether the overall approach was feasible in inpatient settings.
Anaerobic exercise interventions in inpatient settings have been limited by a lack of evidence on feasibility and safety.
Methods
This was a pragmatic, single-blind (with participants aware of their allocation), two-arm randomised controlled feasibility trial conducted in three psychiatric residential rehabilitation units in Australia. No a-priori hypotheses were proposed. Participants were randomised 1:1 to either resistance training or aerobic interval training. As a feasibility study the main aim was to help the researchers decide whether to proceed, modify, or abandon further study.
A pragmatic single-blind , two-arm randomised controlled feasibility trial was conducted.
Results
Fifty-four participants were recruited who were 71% male and had an average of three chronic conditions in addition to psychosis. Representing 71% of those initially referred.
Reasons for not participating included transitioning to the community (n=7) and declining participation (n=13). Randomisation to exercise type did not influence participation.
The primary outcomes were:
- Feasibility – in both groups, 88.8% of participants were considered adherent to the intervention.
- Acceptability – self-report questionnaire based on Sekhon’s theory of acceptability.
- Safety – three serious adverse events (1 in resistance training, 2 in aerobic interval training) were reported, and none were related to the exercise.
Conclusions
The authors state that resistance training appears to be both feasible and safe within psychiatric rehabilitation settings for patients with schizophrenia spectrum diagnoses living with chronic illnesses and high body weight.
The authors concluded:
resistance training was feasible and acceptable to people with psychotic disorders, with no serious adverse events and comparable to aerobic interval training.
Resistance training was feasible and acceptable to people with psychotic disorders
Strengths and limitations
A key strength of the study was its well-designed adverse events protocol, which proactively anticipated delayed onset muscle soreness (DOMS) – an expected response to resistance training, but one that can feel extremely unpleasant, especially if you are not expecting it. This level of detail supports safe delivery and provides a useful model for implementation. Importantly, the authors noted that while three participants needed a session rescheduled because of DOMS, no-one withdrew from the programme, which further reassures readers that the protocol was both safe and manageable.
While the findings are encouraging, the study is subject to a number of important limitations. As a feasibility trial, the study was not powered to detect differences in physical health outcomes, and the authors rightly do not claim otherwise. Whilst at an early stage, the absence of a non-exercise control group makes it more difficult to draw conclusions about potential effectiveness. However, the authors note the practical challenges of including a control group in settings where participants are living together, noting that “contamination” would be highly likely.
Another point to note is that this trial was impacted by the COVID-19 Pandemic, which disrupted delivery and practice. Although the study reports participation rates exceeding 70% at 8 weeks, the prospective trial registration did not clearly specify feasibility thresholds in advance, leading the authors to rely on benchmarks from similar research. This limits transparency around whether feasibility criteria were defined a priori or interpreted retrospectively. However, it nonetheless suggests that at least people staying in rehabilitation wards, who are not already active, can and do want to exercise.
Additionally, while it is important not to overburden participants, it is less clear what impact this research had on participants beyond fitness changes – for example, whether there were any effects on mental health, motivation, confidence, daily functioning. The prospective study mentions a qualitative component was planned and would have provided valuable insights into how participants experienced the programme, what they found helpful and/or challenging, and the influence this would have had will not be captured through physical health measures. It is possible that COVID-19 made this unfeasible, but this leaves behind a key gap. Understanding the experiences of people taking part in this programme would have added substantial depth to the findings and strengthened conclusions about real world implications.
The study included a well-designed adverse events protocol, which proactively anticipated delayed onset muscle soreness (DOMS).
Implications for practice
Despite the limitations, this study offers an exciting and important insight: resistance training can be delivered safely and acceptably in inpatient rehabilitation settings, demonstrating genuine feasibility. This finding directly challenges long-held assumptions about what is possible when improving physical health in those with schizophrenia.
This study therefore creates a clear roadmap for “what comes next”. Future efficacy trials – perhaps using cluster-controlled methodology to reduce “contamination” between study arms appear warranted. With this groundwork in place, research can begin to expand and develop physical health interventions that are not only evidence-based, but realistic, respectful and accessible for people living within inpatient mental health services. This project makes one thing undeniably clear: better physical health care in inpatient mental health settings isn’t a distant goal, it’s an achievable reality.
Better physical health care in inpatient mental health settings isn’t a distant goal.
Statement of interests
SA is someone living with schizophrenia who has been frustrated at the lack of exercise opportunities available for patients (including herself) when receiving inpatient treatment. BM is a hyrox queen!
SA and BM used Microsoft Co-Pilot to aid with grammar and sentence structure in developing this blog.
Edited by
Simon Bradstreet.
Links
Primary paper
Nicole Korman, Robert Stanton, Mike Trott, Brendon Stubbs, Andrea Baker, Cassandra Butler, Dan Siskind, Simon Rosenbaum, Joseph Firth, Rebecca Martland, Talia McIntosh, Nicola Warren, Edward Heffernan, Frances Dark, Justin Chapman. (2025). The feasibility of resistance training versus aerobic exercise in a rehabilitation setting for people living with psychotic disorders: A randomised controlled trial. Aust N Z J Psychiatry.
Other references
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., Chatterton, M., Correll, C. U., Curtis, J., Gaughran, F., Heald, A., Hoare, E., Jackson, S., Kisely, S., Lovell, K., … Thornicroft, G. (2019). The Lancet Psychiatry Commission: A blueprint for protecting physical health in people with mental illness. Lancet Psychiatry, 6(19), 1–39.
Solmi, M., Basadonne, I., Bodini, L., Rosenbaum, S., Schuch, F. B., Smith, L., Stubbs, B., Firth, J., Vancampfort, D., & Ashdown-Franks, G. (2025). Exercise as a transdiagnostic intervention for improving mental health: An umbrella review. Journal of Psychiatric Research. 184:91.
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., Probst, M., Ward, P. B., Gaughran, F., & De Hert, M. (2017). Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: A global systematic review and meta‐analysis. World Psychiatry, 16(3), 308–315.
