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Physical activity effective add-on treatment for severe mental illness

Brendon Stubbs

A position paper issued by the European Psychiatric Association supported exercise as a core additional treatment for severe mental illness.

Evidence from a comprehensive meta-analysis published in European Psychiatry showed that use of physical activity interventions can help in the treatment of major depressive disorder and schizophrenia-spectrum disorders.

“People with serious mental health conditions die up to 20 years early due to physical conditions such as cardiovascular disease,” Brendon Stubbs, PhD, from the Institute of Psychiatry, Psychology & Neuroscience at King's College London, and head of physiotherapy at South London and Maudsley NHS Foundation trust, told Healio Psychiatry.

“The main focus for treatment for serious mental conditions is medication and psychological therapy, which are not designed to improve physical health (or prevent the scandal of premature mortality) and are not universally successful in improving mental health symptoms,” he continued. “Physical activity and exercise are very effective for preventing and managing cardiovascular disease, promoting healthy aging and may also improve mental health symptoms. However, the evidence for the total benefits of physical activity for serious mental health conditions was not available.”

For their guidance paper, conducted in accordance with the European Psychiatric Association guidelines framework and based on the findings from systematic reviews and meta-analyses, researchers searched clinical databases for studies investigating physical activity/exercise among people with severe mental illness, schizophrenia-spectrum disorders, bipolar disorder or MDD.

The investigators examined changes in the severity of psychiatric disorder symptoms as the primary outcome. Secondary outcomes included physical health factors; cardiorespiratory and muscular fitness; increasing physical activity levels or decreasing sedentary behavior; cognitive functioning; brain structure and connectivity; and quality of life and functioning.

“Aerobic and resistance exercise of 90 to 150 minutes each week for 12 weeks delivered by qualified health professionals can reduce mental health symptoms of depression and schizophrenia as well as improve some physical health markers,” Stubbs explained.

Results from the meta-analysis revealed that this level and frequency of moderate intensity aerobic exercise improved cognition and cardiorespiratory health in schizophrenia-related spectrum disorders, according to a press release. In addition, the results showed that combining aerobic with resistance exercise improved outcomes for people with schizophrenia and MDD.

Based on findings from the systematic review, Stubbs and colleagues also offered 10 recommendations for future research and clinical practice to address gaps and limitations.

The researchers recommended that future research focus on:

• the effects of physical activity interventions during the early phase of mental illness onset;
• establishing pragmatic methods for delivering exercise as a treatment for severe mental illness;
• determining the optimal dose-response of physical activity needed and implementing it into clinical practice;
• examining the effects of interventions to reduce sedentary behaviors;
• the underlying neurobiological mechanisms of exercise in severe mental illness; and
• long-term and cost-effectiveness of physical activity interventions.

For clinical practice, physical activity was recommended:

• as a treatment for mild to moderate depression to improve symptoms and physical fitness;
• as an add-on treatment for schizophrenia to improve symptoms, cognition and quality of life; and
• to improve physical health in people with severe mental illness.

Lastly, they recommended people with severe mental illness be screened for physical activity habits in primary and secondary care.

“It is time for physical activity to move from the fringes of mental health care to a central offering in our multidisciplinary treatment pathways,” Stubbs told Healio Psychiatry. “We hope that the guidelines equip clinicians, people commissioning services to have the knowledge and resources to ensure that physical activity can be offered as part of the treatment for mental illness.” – by Savannah Demko

Disclosure: Stubbs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.