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Telehealth-Based vs In-Person Aerobic Exercise in Individuals With Schizophrenia: Comparative Analysis of Feasibility, Safety, and Efficacy

Background: Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in-person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population. Objective: Examine the feasibility, safety, and efficacy of trainer-led at-home telehealth-based AE in individuals with schizophrenia. Methods: We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of delivery of trainer-led AE training among participants undergoing in-person (pre-COVID-19; n=23) vs. at-home telehealth AE (post-COVID-19; n=14). Results: The telehealth and in-person participants attended similar number of exercise sessions across the 12-week interventions (26.8 ± 10.2 vs. 26.1 ± 9.7, respectively; p=0.837) and had similar number of weeks with at least one exercise session (10.4 ± 3.4 vs. 10.6 ± 3.1, respectively; p=0.789). The telehealth-based AE was associated with significantly lower drop-out rate (telehealth: 0/14, 0%; in-person: 7/23, 30.4%; p=0.039). There were no significant group differences in total time spent exercising (telehealth: 1246 ± 686 minutes; in-person: 1494 ± 580 minutes; p=0.284), however over the 12-week intervention, the telehealth group had significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3% ± 21.4%, in-person: 63.5% ± 16.3%, p0.999) or in the percentage of weeks per participant with at least one exercise-related adverse event (telehealth: 31% ± 33%, in-person: 40% ± 33%, p=0.436). There were no significant differences between the telehealth vs. in-person groups regarding changes in aerobic fitness as indexed by VO2max (p=0.27). Conclusions: Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings’ clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for implementation of telehealth-based AE among people with schizophrenia.