People living with severe mental illnesses such as schizophrenia, bipolar disorder and major depression die significantly earlier (10 to 20 years reduction) than the general population.
Much of this shortened life expectancy is not caused directly by suicide or accidents, but by preventable physical illnesses, particularly heart disease and diabetes. New research brings renewed attention to a factor that may help close this gap — regular physical activity.
Mental illness and health
Severe mental illness refers to long‑term psychiatric conditions that substantially affect daily functioning. Alongside psychological symptoms, many people with these conditions experience poor physical health. Rates of obesity, cardiovascular disease and type 2 diabetes are markedly higher than average.
Low levels of physical activity are common in this group. International guidelines recommend at least 150 minutes of moderate activity, such as brisk walking, each week, or 75 minutes of more vigorous exercise.
Yet studies show that fewer than one in five people with schizophrenia meet these targets, and people with depression or bipolar disorder are far less active than their peers.
What the new evidence shows
A major review published in JAMA Psychiatry has pulled together findings from several hundred studies and meta‑analyses involving tens of thousands of patients. The work was led by researchers at the Medical University of Vienna.
The authors report that structured exercise programmes are linked to moderate to large improvements in depressive symptoms, psychotic symptoms, thinking and memory, quality of life, and physical health measures related to heart disease and metabolism. These findings are based on human studies, many of them randomised controlled trials.
In plain terms, people with severe mental illness who take part in regular, planned exercise tend to feel mentally better and show measurable improvements in physical health. Despite this, the review notes that exercise is still rarely built into routine psychiatric care.
How physical activity may help
The review outlines several biological processes that appear to link inactivity with both mental and physical illness.
Low activity levels can disrupt the body’s stress response system, known as the hypothalamic–pituitary–adrenal (HPA) axis. This disruption is associated with higher levels of inflammation, including markers such as C‑reactive protein and interleukin‑6. Chronic inflammation has been linked to both cardiovascular disease and worsening mental health symptoms.
Inactivity is also associated with changes in brain chemistry. Reduced dopamine activity can affect motivation and reward, making it harder to start or maintain healthy behaviours. Levels of brain‑derived neurotrophic factor, a protein important for brain health and mood regulation, are often lower.
Exercise appears to counter many of these changes. Regular physical activity can lower inflammation, improve stress regulation, support healthy dopamine signalling and increase levels of brain‑derived neurotrophic factor.
How strong is the evidence?
The evidence linking exercise with better mental and physical health in severe mental illness is relatively strong compared with many lifestyle interventions. The review draws on a large body of research, including meta‑analyses, which combine results from multiple studies.
However, the authors acknowledge limitations. Exercise programmes vary widely in type, intensity and duration, making it difficult to identify the most effective approach for every individual.
Some studies are short‑term, so less is known about long‑term adherence and outcomes. Exercise is also not a standalone treatment and does not replace medication or psychological therapy.
What this means for patients and the public
The findings do not change existing medical advice, but they strengthen the case for treating physical activity as a core part of mental health care rather than an optional extra. For patients, this may mean being offered structured support to become more active, tailored to their abilities and preferences, as part of routine treatment.
Importantly, the review emphasises that inactivity is not simply a lifestyle choice. Symptoms such as low motivation, fatigue and social withdrawal can make exercise particularly challenging for people with severe mental illness.
Implications for treatment and services
The authors propose using a practical framework known as the “5A” model to integrate physical activity into everyday psychiatric care. This involves asking about activity levels, assessing readiness to change, advising on suitable exercise, assisting with goal‑setting and arranging follow‑up.
Because this approach can be delivered by a range of mental health professionals, it could be implemented without creating entirely new services. The researchers argue that failing to address physical inactivity contributes to one of the starkest health inequalities in modern medicine.
What remains unknown
Key questions remain about how best to sustain exercise habits over the long term, particularly during periods of illness relapse. More research is also needed to determine which types of activity are most effective for different diagnoses and how exercise can be adapted for people with physical limitations.
A broader perspective
The review reinforces a growing recognition that mental and physical health cannot be treated in isolation. While exercise is not a cure, the weight of evidence suggests it can meaningfully improve both quality of life and life expectancy for people with severe mental illness.
Integrating physical activity into psychiatric care will not solve all the challenges faced by this population, but it represents a practical, evidence‑based step towards reducing a long‑standing and preventable health gap.
The post Exercise Should Be Part of Routine Mental Health Care, Review Concludes first appeared on PP Health Malaysia.
