Benefits of Exercise in Early Psychosis

1. Acceptability and feasibility
These will be assessed by analysing referral and recruitment rates, drop out rates and completion of assessment protocols. This includes assessment of number and proportion consenting to pre- and post-intervention physical and mental health assessments, fitness assessments, cognitive testing and brain scans, and numbers completing the exercise intervention. This will be assessed at the end of the study, by looking at consent and attrition rates (01/11/2014).

1. Positive and negative psychotic symptoms, depressed mood, anxiety, social functioning and quality of life will be assessed at baseline and at the end of the 10 week intervention. These will be assessed with the Postive and Negative Symptoms Scale (PANSS), the Beck Depression Inventory II (BDI-II), the Social Interaction Anxiety Scale (SIAS), the Social and Occupational Functioning Assessment Scale (SOFAS) the WHODAS (39) and the WHO Quality of Life 26 item version (WHOQoL Bref) respectively.
2. Cognitive function will be assessed at baseline and after the 10 week intervention. Participants will be seated at a laptop computer and will complete a series of computerised tasks. These tasks are very similar to the types of tests included in popular "brain training" packages available on the internet or on handheld gaming devices. In each task participants will be presented with stimuli (which will be either words, pictures, faces or shapes) and will be asked to make decisions about those stimuli. The different tests will assess a range of mental processes; for example, memory, planning and attention to information.
3. Change in brain structure relative to baseline: We will acquire structural images on the 3T Philips scanner at the Wellcome Trust CRF, using T1 weighted imaging sequences optimized for voxel based morphometry analysis. Individuals will be scanned before and after the intervention and we will use voxel based
morphometry within SPM12 (statistical parametric mapping: www.fil.ion.ucl.ac.uk/spm) to explore grey matter changes. We will use a region of interest approach to explore changes in the hippocampus and temporal gyri.
4. Resting state brain connectivity: Functional imaging data will be acquired in the same scanning sessions as the structural data. Participants will be asked to rest with their eyes closed for 8.5 minutes. During this time, 256 images will be acquired using an echo-planar T2* imaging sequence. Images will be spatially pre-processed and then analysed using the functional connectivity toolbox within SPM.
5. Weight, height, body mass index (BMI), blood pressure and waist circumference will be assessed by standard procedures by the research team at baseline and at the end of the 12 week intervention. Hba1c, lipoproteins and inflammatory markers will be measured by blood test using 12 ml venous blood.
6. Aerobic fitness: sub-maximal exercise assessment will be conducted during incremental exercise on a cycle ergometer. Participants will wear a heart rate monitor and will breathe through a mouth-piece so that O2 and CO2 from expired gas can be measured using a metabolic cart. Outcome measurements from this assessment will include the assessment of the respiratory exchange ratio to indicate substrate utilization (greater fat oxidation indicates better health status), heart rate at an exercise intensity of 50 Watts (lower heart rate after training indicates increased stroke volume) and increased VO2submax indicates better overall health status.