Introduction: Schizophrenia is a disabling psychiatric disorder characterized by positive and negative symptoms and persistent cognitive deficits that impair functioning, autonomy and quality of life. These deficits appear early, persist across the illness and strongly determine prognosis. Because pharmacological treatments have limited cognitive efficacy, interest in complementary non-pharmacological approaches has increased, with physical exercise emerging as a promising intervention.

Objectives: To analyse evidence on the effects of physical exercise on cognitive domains in schizophrenia, considering modality, intensity, duration and underlying neurobiological and psychosocial mechanisms.

Methodology: A PRISMA-guided search was conducted in PubMed, Scopus and PubPsych. Studies until 2024, in English or Portuguese, evaluating exercise effects on cognition in adults with schizophrenia were included. After eligibility criteria, 18 studies (n=3235) were analysed, including randomized controlled trials, cohort, observational and multimodal interventions. Quality was assessed using GRACE and risk of bias using RoB 2.

Results: Studies showed positive but heterogeneous effects. Aerobic exercise produced the most consistent improvements, mainly in attention, processing speed and working memory, particularly when structured, supervised and moderate-to-high intensity. Resistance, flexibility and mind-body interventions showed smaller effects. Neuroplasticity, Brain-Derived Neurotrophic Factor modulation and cortical network reorganization are plausible mechanisms. Reduced negative symptoms, increased motivation and adherence also influenced outcomes.

Conclusion: Physical exercise, especially aerobic training, is a promising adjunctive treatment for cognitive impairment in schizophrenia. However, small samples and lack of protocol standardization require further research to determine optimal parameters and long-term benefits.

Paulo Vieira is a final-year medical student with a strong academic and clinical interest in psychiatry, which he intends to pursue as his future specialty. Throughout his training, he has developed a particular focus on the interaction between mental health, cognition, and lifestyle factors, including physical exercise. His current work represents his final academic project, focusing on the impact of physical exercise on cognitive function in patients with schizophrenia. This reflects his broader interest in understanding psychiatric conditions from both clinical and research perspectives, particularly the role of non-pharmacological interventions in improving patient outcomes. He is especially interested in how emerging evidence can be translated into practical approaches that enhance quality of life and functional recovery. He values a holistic and patient-centered approach, recognizing the importance of integrating biological, psychological, and social factors in mental health care. He is eager to further develop his knowledge and clinical skills in psychiatry, contribute to research in the field, and engage with the international scientific community.