Meta-analysis: Exercise significantly decreases suicide attempts

Key takeaways:

• Exercise was effective in decreasing suicide attempts but not ideation.
• Primary care providers should prescribe exercise to patients with physical or mental illness more often, according to researchers.

Exercise significantly decreased suicide attempts, according to researchers, highlighting the importance of prescribing exercise to patients with mental illnesses.

Previous research has indicated that exercise is beneficial for mental health management. In fact, a recent umbrella review found that all modes of physical activity were effective in improving both anxiety and depression and should be used more frequently for mental health management. But little is known about how exercise might affect suicidal tendencies.

Nicholas Fabiano, MD, a resident with the department of psychiatry at the University of Ottawa, told Healio that “those with mental or physical illness are at an increased risk of suicide compared to the general population.”

“As suicide rates are on the rise, it is important that we find methods to counteract this,” he said. “I can personally speak to the beneficial cognitive and physical aspects of regular exercise. No matter how busy residency is, I maintain a regular exercise routine which has improved my mood, decreased anxiety levels and significantly improved my academic performance.”

To better understand how exercise may affect suicidal ideation or risk, Fabiano and colleagues conducted a systematic review and meta-analysis of 17 randomized controlled trials with 1,021 participants. Their findings were recently published in the Journal of Affective Disorders.

The researchers noted that depression was the most commonly included condition in the review, at 59%, and aerobic exercise was the most common form of exercise studied, at 53%. The other forms of exercise included mind-body (17.6%) and strength training (17.6%).

Fabiano and colleagues found that exercise significantly decreased suicide attempts (OR = 0.23; CI 0.09–0.67). However, there was not a significant decrease in mortality or suicidal ideation between the control and exercise groups (standardized mean difference = -1.09; 95% CI, -3.08 to 0.9).

“However, these lack of associations were likely due to the limited number and sample size of existing studies,” Fabiano said. “As more randomized controlled trials are conducted in this area, I expect that we will see decreases in both suicidal ideation and suicide deaths due to larger sample sizes.”

These findings, Fabiano said, “demonstrate that exercise may be an effective way to reduce suicidal behaviors among those with mental or physical illness.”

A common misconception among primary care providers, Fabiano said, “is that patients, particularly those suffering from mental or physical illness, are not willing or motivated enough to participate in an exercise regime,” which has resulted in providers under-prescribing exercise to those who have physical or mental illnesses.

“In our study, there was no significant difference in dropouts between those randomized to exercise compared to inactive controls. This finding demonstrates that those with mental or physical illness are able to adhere to exercise regimes,” he said. “As a result, we recommend that providers do not have apprehension about prescribing exercise to patients with mental or physical illness.”

Fabiano and colleagues wrote that their review “was a crucial first step to understand the influence that exercise may have on suicide in people with mental or physical illness,” but called for higher quality randomized controlled trials that “explore the effect of exercise in a variety of mental and physical health conditions in order to get a more complete view.”