Effects of 12-week multicomponent exercise on physical function in middle-aged and older patients with schizophrenia: a randomized controlled trial

Physical function decline is associated with disability and reduced quality of life in patients with schizophrenia. This study aimed to investigate effects of a tailored multicomponent exercise program on physical function in middle-aged and older patients with schizophrenia. Middle-aged and older inpatients (≥ 45 years) with schizophrenia were enrolled and randomly assigned to either a 12-week multicomponent exercise program or to treatment as usual. The primary outcome was the Short Physical Performance Battery (SPPB) score. Secondary outcomes included cardiorespiratory endurance, balance, muscle strength, and muscle mass. Data were primarily analyzed using a modified intention-to-treat approach (mITT). A sensitivity analysis was conducted in the full intention-to-treat (ITT) population using multiple imputation. Of the 102 randomized participants, 93 were included in the primary mITT analysis, and all 102 were included in the ITT sensitivity analysis. In the mITT analysis, the multicomponent exercise group showed significantly better performance than the treatment as usual group in the SPPB total score (mean difference, 1.16 points; 95% CI, 0.57 to 1.74; p < 0.001) and the Timed Up and Go Test (TUGT; mean difference, − 1.37 s; 95% CI, − 2.33 to − 0.42; p = 0.005) after the intervention. Consistent with the mITT findings, the ITT sensitivity analysis showed significant group × time interactions for the SPPB, TUGT, and handgrip strength (HGS; all p < 0.001), although the between-group difference in HGS after the intervention was not statistically significant ( p = 0.058). In contrast, the significant interaction effects for the six-minute walking test, appendicular skeletal muscle mass, and appendicular skeletal muscle mass index observed in the mITT analysis were not confirmed in the ITT sensitivity analysis (all p > 0.05). The 12-week multicomponent exercise program produced consistent improvements in overall physical function, balance, and mobility in middle-aged and older inpatients with schizophrenia. However, the effects on cardiorespiratory endurance, handgrip strength, and muscle mass remain inconclusive. These findings support the potential value of incorporating multicomponent exercise into routine psychiatric inpatient care to promote physical function. This trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500105977) on 15 July 2025.