Multimodal Physical Exercise Program (Physical Exercise for Psychosis) for People With Psychosis Treated With Long-Acting Injectable Antipsychotics

Body mass/weight measured in kilograms using a calibrated scale.

BMI calculated as weight (kg) / height (m²)

Body fat percentage assessed by electrical bioimpedance analysis

Lean body mass (kg) assessed by electrical bioimpedance analysis

Used to measure lower limb strength and endurance through the number of repetitions performed in a specific period.

Used to assess upper limb muscle strength

The European Health Interview Survey - Quality of Life 8-item Index (EUROHIS-QOL-8) is an 8-item self-report questionnaire assessing overall quality of life across physical, psychological, social, and environmental domains. Each item is rated on a 5-point Likert scale, resulting in a total score ranging from 8 to 40. Higher total scores indicate better perceived quality of life. The scale demonstrates good psychometric properties and is suitable for use in clinical and research settings.

The Patient Health Questionnaire-9 (PHQ-9) is a 9-item self-administered questionnaire designed to assess the severity of depressive symptoms based on the diagnostic criteria for major depressive episodes. Each item is scored on a 4-point Likert scale (0-3), yielding a total score ranging from 0 to 27. Higher total scores indicate greater severity of depressive symptoms. The PHQ-9 is widely used in clinical and research settings and demonstrates good psychometric properties.

The Positive and Negative Affect Schedule (PANAS) is a 20-item self-report questionnaire designed to assess affective states, comprising two independent 10-item subscales: Positive Affect (PANAS-PA) and Negative Affect (PANAS-NA). Each item is rated on a 5-point Likert scale (1-5), yielding subscale scores ranging from 10 to 50. Higher scores on the Positive Affect subscale indicate higher levels of positive affect, whereas higher scores on the Negative Affect subscale indicate higher levels of negative affect. The PANAS is widely used in clinical and research settings and demonstrates good psychometric properties.

Serum BDNF concentration quantified using standardized Human BDNF ELISA Kit (Abcam). BDNF is a key neurotrophic marker associated with neuroplasticity and treatment-related neurobiological adaptations. Units: ng/mL.

Assessment of serum lipid parameters including total cholesterol, HDL cholesterol, LDL cholesterol (direct or calculated), and triglycerides, according to hospital laboratory reference standards. Units: mg/dL.

Hospital laboratory references:

• Total cholesterol: < 200 mg/dL
• LDL cholesterol: < 130 mg/dL
• HDL cholesterol: > 60 mg/dL
• Triglycerides: < 150 mg/dL

Evaluation of fasting blood glucose and glycated hemoglobin (HbA1c) as indicators of glycemic control and metabolic health.

Units:

• Glucose: mg/dL
• HbA1c: %

Hospital reference values:

• Glucose: 74-106 mg/dL
• HbA1c: 4.0-6.0 %

Quantification of serotonin concentration in serum using standardized laboratory procedures. Higher or lower concentrations will be interpreted as neurochemical modulation potentially associated with the exercise intervention and antipsychotic treatment.

Unit: ng/mL

Quantification of dopamine concentration in serum using standardized laboratory procedures. Changes in dopamine concentration across timepoints will be analyzed as a marker of neurochemical modulation potentially associated with the exercise intervention and antipsychotic treatment.

Unit: ng/mL or pg/mL

Height measured in meters using stadiometer (baseline only, if applicable)

The sociodemographic characterization of participants will be performed using a structured questionnaire designed to collect information on variables such as age, gender, marital status, education, employment status, and family context. This instrument provides a comprehensive description of the sample profile and enables the analysis of potential sociodemographic factors associated with the clinical and functional variables under study.