A Randomised Feasibility Trial of a Service‐Coordinated Exercise Intervention in First‐Episode Psychosis: Challenges in Implementation and Outcome Assessment

Background: Psychosis is increasingly recognised as a systemic disorder characterised by interrelated metabolic dysfunction, chronic low-grade inflammation and sedentary lifestyles. Physical exercise is a promising intervention to address this triad. This pilot study investigated the feasibility and systemic impact of a pragmatic exercise intervention within a first-episode psychosis (FEP) service. Methods: We conducted a parallel-group randomised controlled trial involving people with FEP, comparing an 8-week structured aerobic and resistance training programme to Treatment As Usual. We assessed feasibility of the intervention and assessments by measuring recruitment, attendance, retention, and engagement with assessments. Exploratory outcome measures spanned physical fitness, metabolic health, psychometric scales and the Cambridge Neuropsychological Test Automated Battery (CANTAB) cognitive battery. Results: The study recruited 40 participants, 19 in the intervention and 21 in the control group. At baseline assessment, 23 of 38 had an elevated BMI and 24 of 35 had elevated cholesterol. Study retention was adequate, with only four participants (10%) lost to follow up. However, the assessment battery was poorly completed, highlighting its infeasibility. Fitness outcomes proved especially challenging, with between 11 and 13 participants (27.5% to 32.5%) completing both baseline and endpoint assessments. Of the 19 people recruited to the intervention arm, 7 (36.8%) attended less than half of the 8 sessions. Outcome data were limited by substantial missingness, with no consistent pattern of benefit or harm observed across domains. Conclusions: Implementing exercise within real-world FEP services is challenging as indicated by the attrition observed in our study. Future research should individualise exercise prescription and minimise participant assessment burden to mitigate attrition.