Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies

Figures & data

Table 1 Compensatory Strategies to Facilitate Behaviour Change Across Two Stages of PA Behaviour Engagement

	Stage of PA Across Time
Intervention goal:	Initiation (adoption), days/weeks	Habit formation, months/years
Behavioural level:	Starting with low-effort activities and increasing training and repetition frequency	Long-term sustaining of regular engagement in chosen activities
Psychological level:	Anticipating a reward and choosing an appropriate goal-directed action	Regular engagement of habitual PA with little conscious effort, less dependent on self-control
Types of motivation (regulation):	Extrinsic motivation (from external to integrated regulation); goal-directed	Intrinsic motivation (intrinsic regulation); automatic, habit-directed
Motivational sub-processes:	Reward-driven approach and goal-directed action	Habit formation
Impairments in schizophrenia:	- Impaired reward prediction (negative prediction error) - Temporal discounting - Anticipatory reward deficits - Reduced selection of high-effort activities - Impaired associative learning	- Worsening of symptoms - New barriers - Change in regular routines - Shifts in priorities - Complacency
Main neural circuits:	Ventral (limbic) striatum, anterior cingulate cortex and dorsolateral prefrontal cortex, dorsomedial (associative) striatum	Dorsolateral (sensorimotor) striatum and infralimbic cortex
Compensatory strategies to increase PA:	- Start with low-effort activities and increase their intensity only when positive rewards are more likely - Focus on PA that elicits pleasure and enjoyment, or is fun, considering green spaces, sport and recreation in addition to traditional gym exercise based on preference - Provide constant feedback and frequent and immediate priming with motivating rewards - Offer supervised activities preferably delivered by an exercise professional - Facilitators may encourage reflection on the experience of pleasure resulting from PA when planning future activities - Identify personal motivations (long-term goals), capacities and barriers - Still reinforce frequently with positive feedback and novel rewards and activities, but slowly transition towards planning and establishing a PA routine - Assist with planning exercise sessions, including exercise clothing and food before sessions, transport, use of a weekly calendar - Continue to prompt with social support	- Elicit autonomous motivation to improve computing the reward value of PA and reduce the need for making conscious mental computations of the rewards by habituating the behaviour - Ensure consistent cueing of PA using environmental cues (same time, day, trainer or support worker, favourite music) to make behaviour more automatic and reduce mental load - Provide professional support and plan monitoring strategies - Encourage associating successful engagement in PA with an individual’s long-term goals, development of self-talk statements that connect actions to aspirations

Note: The compensatory strategies have been informed by Kesby et al (2021), Conn et al (2021), Kim (2013) and Lally and Gardner (2013).

Abbreviation: PA, physical activity.