People with mental illnesses such as schizophrenia, depression or bipolar disorder die on average ten to 20 years earlier than the general population. The main causes of this are cardiovascular and metabolic diseases, which are triggered or exacerbated by a lack of exercise. Now, an international team of scientists led by MedUni Vienna is calling for physical activity to be recognised as an integral part of psychiatric treatment and is also describing specific steps for successfully integrating it into practice. The review has been published in the renowned journal JAMA Psychiatry.
The scientific publication, led by Brendon Stubbs (Comprehensive Centre for Clinical Neurosciences and Mental Health and Department of Psychiatry and Psychotherapy, Medical University of Vienna), summarises the results of several hundred studies and meta-analyses, some of which involved more than 10,000 patients. The scientists conclude that structured exercise brings about moderate to large improvements in depression, psychotic symptoms, cognitive performance, quality of life and cardiometabolic health – yet systematic integration into psychiatric care is rare.
Lack of exercise as a symptom and risk factor
People with schizophrenia, for example, spend an average of almost ten hours a day sitting down – more than almost any other population group. Less than 20 per cent of them meet the WHO's recommendations for at least 150 minutes of moderate or 75 minutes of intense physical activity per week. People with depression or bipolar disorder are up to 50 per cent less likely to be sufficiently active than their peers. These patterns are not just a symptom of the illness: they actively accelerate cardiometabolic disorders such as cardiovascular disease or diabetes. They exacerbate inflammatory reactions in the brain (neuroinflammation), which can disrupt communication between nerve cells and lead to cognitive impairment. In addition, lack of exercise exacerbates psychiatric symptoms in a vicious circle.
The biological mechanisms behind this are explained in the review: Lack of exercise disrupts the stress hormone system (HPA axis), increases inflammatory markers such as C-reactive protein and interleukin-6, impairs dopamine reward circuits that are linked to motivation, among other things, and reduces levels of BDNF (brain-derived neurotrophic factor), a key protein for brain health and mood. Exercise reverses many of these processes. "The evidence is clear: physical activity is a safe, effective and scalable therapy for people with severe mental illness. We would not accept psychiatric treatment that did not offer medication or psychotherapy. It is time to apply the same standard to exercise," demands Brendon Stubbs.
The review describes how exercise can be successfully integrated into psychiatric care using the 5A model (Ask, Assess, Advise, Assist, Arrange): It enables any mental health professional to identify inactivity, assess readiness to change behaviour, provide personalised recommendations, support motivation and goal setting, and organise progress checks and follow-up appointments – all within a normal clinical consultation. Stubbs: "The drastically reduced life expectancy of people with severe mental illness is one of the most shameful inequalities in modern medicine. Exercise is not a panacea, but it is a proven, universally accessible and cost-effective tool that can really help reduce this inequality."