# Occupational therapist‐guided exercise increased white blood cell and neutrophil counts during clozapine treatment: A case report

## TL;DR

Supervised exercise by an occupational therapist helped increase white blood cells in a patient on clozapine, a schizophrenia medication that can lower these cells.

## Contribution

This case report shows supervised exercise can stabilize blood cell counts during clozapine treatment, which is novel in mental health and exercise medicine.

## Key findings

- Supervised exercise increased white blood cell and neutrophil counts in a clozapine-treated patient.
- Exercise with occupational therapist supervision was more effective than self-training.
- The patient maintained normal blood cell levels and continued clozapine treatment for two years.

## Abstract

Moderate exercise increases white blood cells and neutrophils. However, there are no reports on the relationship between exercise intensity and these cells. We observed a patient taking clozapine whose white blood cell and neutrophil counts were borderline. Supervised exercise therapy with an occupational therapist stabilized these counts.

A 50‐year‐old woman with treatment‐resistant schizophrenia was prescribed clozapine. By Day 63, the clozapine dosage had been increased to 450 mg/day. Additionally, she was advised to perform a 30‐min walking exercise program 1 h before blood tests. Exercise therapy supervised by an occupational therapist was performed eight times, and self‐training was performed five times. Exercise intensity was monitored using the Borg Scale for subjective evaluation and the Karvonen formula for objective evaluation. Supervised exercise therapy with an occupational therapist resulted in greater increases on the Borg Scale and Karvonen formula than did self‐training. It also induced increases in white blood cells and neutrophils. Her psychiatric symptoms improved, and she was discharged on Day 71. A blood test taken after discharge revealed that her white blood cell and neutrophil counts were within the normal range and she continued to take clozapine for 2 years. She has since been able to enjoy a calm and relaxed life at home.

Exercise involving subjective and objective evaluation by an occupational therapist effectively increased white blood cells and neutrophils during clozapine treatment. Supervised exercise therapy by an occupational therapist is important when self‐exercise is insufficient for continuing clozapine treatment.