The Effect of Combined Brain Stimulation and Exercise for Improving Cognitive Function in Schizophrenia

A Chinese verbal memory test designed to assess the processes and organizational strategies involved in learning verbal information. The test consists of two different 16-item two-character Chinese word lists, namely the random and blocked conditions. Total learning score, short-term, and long-term memory will be recorded in both conditions.

A measure of sustained attention. A white box is shown in the center of the screen, inside which digits from 2 to 9 appear in a pseudo-random order, at the rate of 100 digits per minute. Participants are requested to detect target sequences of digits (for example, 2-4-6, 3-5-7, 4-6-8). When the participant sees the target sequence, they must respond by selecting the button in the center of the screen as quickly as possible. The level of difficulty varies depending on whether the participant must watch for one- or three-target sequences at the same time.

A measure of verbal short-term and working memory. The participant will hear a sequence of digits and will immediately be prompted to verbally repeat it. If the participant responds correctly, the next trial presents a longer sequence. The task terminates when participants respond incorrectly on three occasions at a span length.

A measure of executive function. Participants have to name as many animals as possible in 60 seconds.

A sub-maximal exercise test to assess the aerobic capacity and endurance. The subject has to walk as far as possible along a track for 6 minutes.

A 10-item self-report instrument that evaluates fatigue symptoms.

A common measure of flexibility, specifically assessing the lower back and hamstring muscles. The subject is seated against the wall, arms outstretched towards the box. A sliding ruler is used to measure the position of the fingertips.

Give the subject a minute to practice their balancing before starting the test. Then ask the person to stand on one foot for as long as possible. The total length of time a person can stay in the balance position will be recorded. The timing stops when the elevated foot touches the ground or the person hops or otherwise loses their balance position. The test will be conducted with the person having their arms on their waist. Repeat the test on the other leg.

Measuring symptom severity of patients with schizophrenia. It contains 33 items across three subscales (Positive, Negative, and General), rated from 1-7 on each item based on clinical interviews as well as reports from family members or primary care hospital workers.

A 9-item scale to evaluate depression, rated from 0 to 3.

Both structural and resting-state functional MRI will be acquired on a 3 Tesla MRI scanner (Prisma, Siemens, Germany). For registration purposes, high-resolution T1-weighted anatomical images will be acquired during 3-D MP-RAGE (parameters: slice thickness=1mm, echo time=3.26ms, repetition time=2250ms, inversion time=900ms, flip angle=9°, in-plane voxel size 1×1 mm2, acquisition time=5 minutes). Functional scans (resting state) will use a gradient-echo echo-planar imaging (parameters: repetition/echo time=800/37ms; flip angle=52°; field of view=208mm; 2mm isotropic [no gap]; no. of dynamics=380, acquisition time=5 minutes). The resting fMRI scan will be repeated for 5 times with a total acquisition time of 25 minutes.