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Primary Prevention – Improves mental health

Evidence summary (Updated 2022)
Individuals with serious mental health conditions, such as schizophrenia, are significantly less physically active, more sedentary and have a lower cardiorespiratory fitness level, with increased morbidity & mortality compared to the general population [1]. Physical activity, including the practice of yoga [2] has been shown to treat both the positive & negative symptoms of schizophrenia, when used in combination with pharmacological therapy (and in addition can help to reduce the weight gain associated with drug treatment).
A case-controlled RCT demonstrated that an aerobic exercise intervention improved both negative and general symptoms of schizophrenia, and that the negative symptoms continued to improve after completion. Those with more severe symptoms at the start of the intervention showed a trend towards greater improvement. Although a review of RCTs evaluating exercise interventions did not show a significant change in BMI, it did demonstrate possible improvements in physical fitness and reduced psychiatric symptoms. Participant education and motivation may improve the uptake of physical activity in this group [3].
Physical activity is also associated with neuroprotective effects, such as reduced inflammation, increased neurogenesis & neuroplasticity, and remyelination of white matter tracts [4]. There is good evidence that physical activity can improve the symptoms of mental illness, work is now required to identify the optimal type and dose, as well as strategies for participant uptake and behavioural change.
Recent studies show that overall, there continues to be inconclusive evidence for physical activity as a primary prevention for schizophrenia or psychosis. A recent large (N = 30,025) random effect meta-analysis aimed to examine the prospective relationship between PA and the incidence of these conditions. Results were mixed. Across 4 cohorts there was found to be reduced odds of developing schizophrenia/ psychosis in people with high self- reported PA levels (OR = 0.73, 95%CI 0.532 to 0.995, p = 0.047), whereas in 2 cohorts there was no significant correlation found. (AOR = 0.59, 95%CI 0.253 to 1.383, p = 0.226) [5].
Another 2 – sample Mendelian randomization study utilising summary level data from the UK Biobank (n=91,105) found that there was no association between overall physical activity levels and the risk of developing schizophrenia however they reported that engaging in regular physical activity does have a protective effect against bipolar disorders (OR = 0.49, 95%CI = 0.31-0.76) [6].
Quality of Evidence
Grade B – Moderate evidence

Strength of recommendation

Grade 1 – strong recommendation


Evidence remains inconclusive re primary prevention of serious mental illness although regular exercise may have a protective effect against bipolar disorders. There is good evidence that physical activity can improve the symptoms of serious mental illness. Work is now required to identify the optimal type and dose, as well as strategies for participant uptake and behavioural change.

[1] Eivind Andersen, Tom Langerud Holmen, Jens Egeland, Egil Wilhelm Martinsen, Therese Torgersen Bigseth , Gry Bang-Kittilsen , Sigmund Alfred Anderssen, Bjørge Herman Hansen , John Abel Engh (2018) Physical activity pattern and cardiorespiratory fitness in individuals with schizophrenia compared with a population-based sample. Schizophr Res. 2018 May 31 [epub ahead of print]
[2] Ganguly P, Soliman A, Moustafa AA (2018). Holistic Management of Schizophrenia Symptoms Using Pharmacological and Non-Pharmacological Treatment. Front Public Health. 2018 Jun 7;6:166.
[3] Athif Ilyas , Edward Chesney , Rashmi Patel. (2017). Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention? Br J Psychiatry. 2017 Oct;211(4):194-197
[4] Douglas L Noordsy , Jonathan D Burgess , Kate V Hardy , Lynn M Yudofsky , Jacob S Ballon (2018). Therapeutic Potential of Physical Exercise in Early Psychosis.Am J Psychiatry. 2018 Mar 1;175(3):209-214
[5] Brokmeier L, Firth J, Vancampfort D et al. (2020) Does physical activity reduce the risk of psychosis? A systematic review and meta‐analysis of prospective studies. Psychiatry Res ;284:112675.
[6] Sun H, Gao X, Que X et al. (2020) The causal relationships of device-measured physical activity with bipolar disorder and schizophrenia in adults: A 2-Sample mendelian randomization study. J Affect Disord. Feb 15;263:598-604.