Physical activity is considered good for most individuals, and its benefits are particularly significant in those with mental illness due to levels of distress being higher in this patient cohort.

Physical activity can help relieve this distress and is a key piece in establishing biopsychosocial well-being. Moreover, lack of exercise in this population can exacerbate health inequalities.

 

Scope of the problem

People with severe mental health concerns can be sedentary for between 8 and 12 hours a day, which is compounded by issues such as obesity and social isolation.Although people with mental illness are not likely to engage in the CDC-recommended minimum of 150 minutes of moderate physical activity a week, this can vary based on specific diagnoses.

People with bipolar disorder, for example, are more physically active than those with schizophrenia or major depression. Other factors such as medication side effects can also contribute to decreased physical activity.

In a study published in Psychiatry Research, 62 patients with severe mental illness aged between 26 and 61 years were given surveys and physical tests to assess their fitness.

Perez-Cruzado D, Cuesta-Vargas A, Vera-Garcia E, et al. Medication and physical activity and physical fitness in severe mental illness. Psychiatry Res. 2018;267:19–24.

 

The researchers found that those not taking antipsychotic medications exercised the most, but of the drugs risperidone and olanzapine, only risperidone was associated with significant decreases in physical-fitness levels. Conversely, olanzapine attenuated muscle strength, balance, and aerobic conditioning.

 

Benefits of exercise

Physical activity is beneficial for cardiometabolic health via improved blood-sugar levels, decreased blood pressure, and enhanced heart-lung fitness. Cardiorespiratory fitness is a major predictor of early death in those with severe mental illness. A structured exercise program can decrease cardiometabolic risk in as few as 8 weeks.

As detailed in an open-access textbook titled Essentials of Exercise and Sport Psychology, the benefits of physical activity can be specific to a person’s disorder.

Fibbins H, Lederman O, Rosenbaum S. Physical activity and severe mental illness. Essentials of exercise and sport psychology: An open access textbook 2021;385–408. Society for Transparency, Openness, and Replication in Kinesiology.

 

In major depressive disorder (MDD), physical activity enhances mood and well-being even after one session of moderate or higher intensity exercise. It can also decrease the risk of future depression.

People with bipolar disorder experience reduced fluctuations in mood after exercise.

On a molecular level, chronic stress can moderate MDD via the impairment of signaling in neurotrophins including transforming-growth-factor-β1 (TGF-β1) and brain-derived neurotrophic factor (BDNF).

Stress-mediated depression can interfere with BDNF levels and function in those patients with depression, thus compromising neuroplasticity. Data show that aerobic exercise heightens BDNF production and could serve as a non-pharmacologic therapy to help with cognition and affective symptoms in patients with depression.

“Physical activity can synergize with antidepressant treatment by rescuing neurotrophins signaling in MDD patients, promoting neuronal health and recovery of function in MDD-related circuits, finally enhancing pharmacotherapeutic response,” stated the authors of an article published in Frontiers in Psychology.

Guerrera CS, Furneri G, Grasso M, et al. Antidepressant drugs and physical activity: a possible synergism in the treatment of major depression? Front Psychol. 2020;11:857.

 

This synergism might be particularly relevant in elderly patients with late-life depression.

 

Boosting activity levels

Unless a person with mental illness has profound physical disability or disease, exercise is usually safe to prescribe. Before an exercise intervention is planned, however, it’s important to determine whether the patient with mental illness has any barriers.

These could include fatigue, medication adverse effects, psychotic symptoms, and social anxieties. Importantly, people with high levels of mental distress or poor mental health could need additional support to engage in exercise.

Once a person is cleared for physical activity, various strategies may help. Healthcare providers should take a personalized approach when advising patients with mental illness.

Lack of motivation should be explored, as well as priorities regarding exercise, past experiences, and beliefs.

“Education about how to engage effectively and safely in structured exercise and fostering self-determined motivation through building self-confidence and a sense of competency can improve participation,” wrote the authors of Essentials of Exercise and Sport Psychology.

People may have had previous negative experiences with exercise, which may affect future performance.

"The influences that may dissuade people with mental illness from engaging in physical activity should be discussed by their healthcare providers to formulate an exercise plan that is based on the person’s interests and preferences,” the authors continued.

The authors of a study published in Australasian Psychiatry stressed that individuals with mental illness could also benefit from in-person support, such as a caregiver walking with them.

Chapman JJ, Hielscher E, Patterson S, et al. Preferences of people with mental illness for engaging in exercise programs under COVID-19 restrictions. Australas Psychiatry. 2021;29(2):175–179.

 

Another strategy could involve incentivizing exercise with gift cards and other small gifts.

Home-exercise equipment should be paired with exercise routines for best results.