How Can Exercise Help?
Accumulating evidence suggests that regular exercise positively affects integral functions such as brain health (the ability for the brain to generate new cells and maintain existing cells) and cognition (e.g., ability to think quickly, pay attention, remember things). Likewise, preliminary evidence suggests that aerobic activity has been associated with improved quality of life. Because exercise has been found to stimulate brain health in the hippocampus, and related abnormalities have been widely observed in youth experiencing thought disorder, exercise may be in an important intervention.
Understanding how exercise may protect or improve the health of a brain area that is implicated as a major contributing factor to the onset of psychosis may lead to a path-breaking new intervention that does not suffer from many of the side effects, costs, and other barriers that characterize treatments that are currently available for this group. Because a significant portion of high-risk youth go on to develop more serious mental illness in a brief period, intervening at this stage may be very important.
The goal of this Study is to evaluate adolescent and young adults exhibiting thought disorder to test the feasibility and effectiveness of cardiovascular exercise in promoting:
1) Brain health (improving the maintenance and rate of new cell growth in the hippocampus)
2) Improving related symptoms (e.g., hearing sounds that are not there, feeling emotionally detached from self and others) after the intervention, and then 12 and 24 months later
3) Improving cognitive difficulties (troubles with memory and learning)
4) Improving every day social-occupational functioning after the intervention, and then 12 and 24 months later
As this is the very first study of this type, we are also very interested in learning what frequency and what intensity of exercise might be the most helpful in promoting increased fitness and the most tolerable (i.e., the most likely to keep youth engaged and interested in continuing to exercise). We hope to use these lessons in the formation of the next stage of the trial, which will involve a larger group of participants as well as a waitlist controls group.
How the Study Works (7 Steps):
All assessments are provided at no cost. Participants will recieve incentive payments for attending these steps (specific cash incentives for each step are detailed below):
STEP 1-The initial screening:
Will help to determine if you are a good fit for the study (see inclusion and exclusion criteria below). We will compensate the participant $45.00 for the initial 1.5-hour total interview (regardless of if you are found to be a good fit for our study or not).
STEP 2-Then, if ADAPT is found to be a good fit for you:
You will be invited to participate in an 3-month exercise intervention and two-year longitudinal follow-up study.
Before the Trial begins, we will invite you to participate in the Pre-Exercise Assessment (5 hours total, compensation = $150). This will involve a diagnostic and real-world functioning interview (1.5 hours), cognitive testing (2 hours), structural brain scan (1 hour), and fitness evaluation (which we will use to devise your personalized fitness prescription; 30 minutes).
Note: These assessments can be broken down into shorter visits including nights and weekends depending on what works best for you!
STEP 3- Next, you will be given an oreintation tour of our professional-grade fitness facility:
STEP 4- You will then be randomly assigned to one of two conditions:
A) 2 times a week (1/2 hour each session) for 12-weeks at the intensity of 60% of your personal cardiovascular output (low-moderate intensity). Participants will be compensated $15 each session (a total of $360 for the entire 3 months or 24 sessions).
B) 3 times a week for 12-weeks (1/2 hour each session) at the intensity of 80% of your personal cardiovascular output (high-moderate intensity). Participants will be compensated $15 each session (a total of $540 for the entire 3 months/36 sessions).
Note: A trained exercised physiologist will supervise all sessions. Our equipment involves fully interactive stationary bicycles and treadmills with music and dynamic games. Consecutively attending exercise sessions will be rewarded with lottery tickets to win an I-pad (2 annual drawings). If you do not have transportation, we will pay for a service to both pick you up and drop you off to each session.
STEP 5-After the 3 month trial is over:
You will be invited to complete the Post-Exercise Assessment (5 hours total, compensation = $150). Identical to the Pre-Exercise Assessment, this will involve a diagnostic and real-world functioning interview (1.5 hours), cognitive testing (2 hours), structural brain scan (1 hour), and fitness evaluation (which we will use to devise your personalized fitness prescription; 30 minutes). This will allow for us to determine what types of changes you experiences as a result of the exercise you have just completed over the past several months.
STEPS 6 and 7- Then, 12 months and 24 months later:
You will be invited back in for a check-up interview (3 hours total, compensation =$90 at each of the two annual assessments). During these follow-ups, we will administer the same clinical and real-world functioning inventories that you were given at the Pre and Post Exercise Assessments.
STUDY IS THEN COMPLETE!
Note: Snacks will be available at any of the visits and any costs relating to parking will be reimbursed. $10 dollars will be available to supplement travel/gas costs for the Pre/Post Exercise Assessment time points as well as both the 12 and 24-month follow-ups ($40 total for participation in the duration of the study). As noted earlier, we will also arrange for a free pick up and drop off service for each of the exercise sessions if requested.
Who is Eligible?
Individuals who come to ADAPT have a wide range of concerns they may wish to discuss, such as unusual thoughts and perceptions; increased depression; social anxiety; and greater difficulty with work, school, friends, and family. Individuals who are experiencing difficulty functioning and who have a family member with a psychotic illness such as schizophrenia are also considered to be at risk and are encouraged to contact us.
Referrals to ADAPT can be made by family physicians, pediatricians, psychiatrists, and mental health professionals. If you have a client you think might be appropriate for ADAPT, you are welcome to call us for a consultation at (303) 492-4616. You may also give a brochure to the client or family and have them contact us directly. Individuals interested in help for themselves or someone they know may also contact us directly.
We are happy to answer any questions you may have about ADAPT over the phone. Individuals (or their parent/legal guardian if between 12 and 17) who call and decide they’d like to participate are invited to come to our facility for an initial screening interview. This interview will determine whether you (or your child) are eligible for the ADAPT research program. The interview includes questions about your medical and psychological history. You will be asked to explain how things have been going for you lately and about any symptoms you may be experiencing.
It’s important for you to know that any information you tell us during the interview will remain confidential. You will be asked to sign a consent form before you participate in the screening interview explaining these procedures and making sure you understand your rights as a research participant. If you are 18 years of age or older, you are not required to bring a family member with you to the interview, though family members are welcome.
Who is Not eligible?
The following individuals are not eligible to participate in the Exercise Intervention Study:
*Individuals who are under the age of 16 or over the age of 24
Individuals who have been diagnosed with schizophrenia, schizophreniform disorder, schizoaffective disorder, or delusional disorder
Individuals who have experienced fully psychotic symptoms that started more than 3 months ago
Individuals with IQ below 70
Individuals with a serious neurological disorder (e.g. seizures)
Individuals who have had a major head injury with loss of consciousness
*Individuals who are pregnant (this would prevent the brain scan)
*Individuals who have contraindications to magnetic resonance (MR) scanning including intracranial, intraoribital or intraspinal metal, pacemakers, cochlear implants or other non-MR-compatible devices
*Individuals who are already physically active (exercising vigorously for more than 1 hour a week in the past ½ year)
*Individuals who have taken antipsychotic medication in the past ½ year
*Substance dependence in the past ½ year
Please note: these criteria are different than what is noted for participating in the broader ADAPT study (Detailed on the "How Can We Help?" and "Who is Eligible?" pages). We have indicated where the criteria are different for this smaller study with a “*” above.
The criteria for this smaller study are more narrow (e.g., the age range is shorter, individuals must participate in the structural scan, individuals cannot be already physically active, individuals cannot be recently treated with neuroleptic medications, and individuals cannot have a diagnosis of drug dependence in the past 6 months).
The reason the Exercise intervention is more stringent is because it is a new topic that has not been studied before. Because the study is smaller, we have to exclude factors that may confound our findings. Further the imaging is a central component for the Exercise Intervention but less central to the broader ADAPT study. It is our hope that we will be able to follow-up this smaller study with a larger inclusive investigation after we have determined the goals indicated above. If you have any questions about ability to participate based on these or any other issues, please feel free to contact us for clarification.