The relationship between physical activity and psychiatric medications

By Naveed Saleh, MD, MS | Medically reviewed by Amanda Zeglis, DO, MBA
Published July 27, 2022

Key Takeaways

  • Individuals with mental illness are less likely to exercise, a multifactorial problem exacerbated by their symptoms, obesity, side effects, social isolation, lack of motivation, and negative fitness experiences.

  • Activity levels vary by psychiatric condition, with those diagnosed with bipolar disorder more likely to exercise than patients with major depressive disorder or schizophrenia.

  • Physical activity elicits disease-specific benefits in mood and cognition. Once it’s determined that a patient can exercise, personalized input from a physician and the use of technology tools such as apps can help with motivation.

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.

Antipsychotic medications, in particular, are linked to decreased levels of physical activity, and patients taking them exhibit decreased muscle strength and impaired balance. These medications can also worsen aerobic conditioning in patients.

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.[]

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.[]

In schizophrenia, moderate-to-vigorous physical activity can result in improved positive and negative symptoms, as well as enhancements in global cognition.

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.[]

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

Guerrera, et al.

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."

Fibbins, et al.

"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.[]

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

Technology could also boost adherence and take the form of fitness apps/devices for self-monitoring, home-exercise equipment, and the access to daily exercise routines.

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

What this means for you

Getting motivated to exercise can be difficult, particularly for people struggling with mental illness. This population, however, can experience helpful benefits from exercise through improvements in mood, cognition, and cardiovascular health. When counseling patients on exercise, try to get to the core of their problem. Find out what barriers they face when exercising and develop a plan based on that person’s interests. Consider technology-based strategies such as fitness apps and devices.

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