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EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)
Open accessAbstract
Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes.
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“Thus, moderate-to-vigorous intensity aerobic exercise alone or in combination with resistance training [44] over at least 12 weeks and achieving 90 min per week appears the optimal mode of delivery of structured exercise.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [44]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“However, several recent studies have suggested that exercise is safe in serious mental illness [44,119].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [44]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Notably, the European Psychiatric Association's guidelines 17 on physical activity in mental illness put forth that there is sufficient evidence to recommend structured exercise training as an effective first-line treatment option for moderate depression, and as an adjunctive intervention for improving symptomatic recovery in severe mental illness.”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [17]
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“Whilst not the focus of this review, along with the neuropsychiatric benefits, exercise interventions can also play an important role in reducing the physical health inequalities observed in people with mental illness [44].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [44]
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“Given the mental health benefits, along with the clear potential for exercise to improve the poor physical health among people with schizophrenia [44], further research should now be dedicated towards establishing feasible and sustainable methods for engaging this population with moderate-to-vigorous intensity exercise training in real-world settings.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [44]
In the citing paper
“International public health consortia are in concert with the antidepressant effects of exercise as a low-risk adjunct for optimal mental health 9– 11 .”
In the citing paper
“The contrasting statements conveyed by international treatment guidelines preclude drawing definitive conclusions regarding the role of exercise as a treatment for non-severe depression.”
In the citing paper
“This contradicts the report by the European Psychiatric Association that states that there is sufficient data supporting exercise for the management of mild-to-moderate depression.19”
In the citing paper
“Specifically, the use of exercise as an alternative treatment for non-severe depression is endorsed by several treatment guidelines (EPA in Europe, CANMAT in Canada, NICE in the UK and RANZCP in Australia).19–22”
In the citing paper
“Our findings align with the recommendations provided by European, Canadian, Australian and UK treatment guidelines supporting the use of exercise as an alternative treatment for non-severe depression.19–22”
In the citing paper
“Although many remedial methods, including consuming chemical and herbal medicine and different ways of physical activity to inhibit AD progress, are available, an effective treatment against AD still does not exist (30,31).”
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Metadata
- Authors
- Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., Brand, S., Cordes, J., Malchow, B., Gerber, M., Schmitt, A., Correll, C. U., De Hert, M., Gaughran, F., Schneider, F., Kinnafick, F., Falkai, P., Möller, H.-J., & Kahl, K. G.
- Affiliations
- King's College London (GB)
- KU Leuven (BE)
- Karolinska Institutet (SE)
- The University of Melbourne (AU)
- National Research Council (IT)
- University of Padua (IT)
- University of Basel (CH)
- Heinrich Heine University Düsseldorf (DE)
- Ludwig-Maximilians-Universität München (DE)
- Universidade de São Paulo (BR)
- Hofstra University (US)
- RWTH Aachen University (DE)
- Loughborough University (GB)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Stubbs, Brendon
- ORCID
- Venue
- European Psychiatry
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-07-18
- Volume
- 54
- Pages
- 124-144
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- OpenAlex
- W2887909476
- Semantic Scholar
- 567a3e019a6376dd5c8a6931e3048be7aba1b933
- Cited by
- 697
- References
- 100
- Citations by year
- 2026: 90 · 2025: 83 · 2024: 124 · 2023: 97 · 2022: 87 · 2021: 77 · 2020: 78 · 2019: 58 · 2018: 3
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- edoc (University of Basel) (submittedVersion)
- Figshare (submittedVersion)
- Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- King's College Hospital NHS Foundation Trust
- Maudsley Charity
- National Institute for Health and Care Research (CL-2017-03-001, ICA-CL-2017-03-001, CL-2017, NIHR-INF-0685)
- Department of Health and Social Care
- King's College London
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- physical activity, severe mental illness, schizophrenia spectrum disorders, major depressive disorder, bipolar disorder, exercise intervention, aerobic exercise, cardiorespiratory fitness, quality of life, cognitive function, adverse events, cost-effectiveness, clinical guidelines
- MeSH terms
- Cardiorespiratory Fitness, Bipolar Disorder, Major Depressive Disorder, Humans, Mental Health, Psychiatry, Psychotic Disorders, Quality of Life, Schizophrenia, Schizophrenic Psychology, Societies, Medical, Societies, Scientific, Exercise, Physical Therapists
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