Differential Responsiveness to Exercise and Cognitive Remediation in Physical Health in People With Schizophrenia: Results From the CORTEX-SP Study.

Non-pharmacological interventions, such as exercise and cognitive remediation, have been widely investigated in people with schizophrenia (SZ), showing beneficial effects and supporting their role as complementary approaches to pharmacological treatment. Moving towards precision medicine, it is important to consider variability in individual responses. Thus, this study aimed to analyse the prevalence of responders regarding body composition, cardiorespiratory fitness (CRF), and sleep quality in people with SZ following exercise or cognitive remediation programmes. A total of 159 participants with SZ (41 ± 10 years) were randomly assigned to the treatment-as-usual (TAU, n = 53), exercise (EX, n = 59), or cognitive remediation programme (REHACOP, n = 47) groups. Anthropometric outcomes, CRF, and sleep efficiency were assessed pre- and post-intervention using standardised methodologies. The typical error (TE) was calculated to identify responders. The EX group showed the highest prevalence of responders in body mass index (21.2%) and fat mass percentage (20%). There were significant improvements in CRF in the EX group (Δ = 21.0%, p < 0.001), with a significantly higher prevalence of responders compared with the REHACOP and TAU groups (p < 0.001). Sleep efficiency also improved significantly in the EX group (Δ = 1.75%, p = 0.004), again with the highest prevalence of responders (27.7%) in this group. These findings suggest that exercise is a particularly effective strategy for enhancing physical health outcomes in people with SZ. However, cognitive remediation may still play a complementary role by supporting the cognitive resources required to maintain exercise engagement and healthy lifestyle changes.