Why should people living with schizophrenia exercise?

    In this section

    Keeping physically active is important for both physical and mental health.1,2 This article looks how people with schizophrenia view exercise, their exercise habits and the barriers that may prevent them from being more active. The many positive benefits of exercise will also be discussed together with a few tips on how to be more active. 


    Exercise and schizophrenia

    Compared to the general population, people with schizophrenia tend to lead unhealthier lifestyles which includes being less physically active.3-7 Sedentary behaviours (like sitting down and watching television) are also more common.3,6 This is important because there is a strong link between physical inactivity, obesity and heart disease.3,6,7 And, as people with schizophrenia already have a higher risk of developing heart disease than those without, being physically inactive can add to this risk.3,6,7
     
    There may be multiple reasons why people with schizophrenia may not be that inclined to exercise.7 It could be because they don’t feel mentally well enough because of their symptoms or treatment, feeling too tired to exercise, or just lack the motivation.7 There may also be misconceptions about the value of exercise or negative voices telling them not to exercise.7
     
    That said, research into what motivates people to exercise has shown that the majority see exercise as a way to improve health.5,8 Many also see it as a means to lose weight, improve body image, lighten mood and reduce stress.5,8 With the right support and encouragement this suggests that people with schizophrenia could exercise just as much as anyone else


    Benefits of exercise for physical and mental health

    Keeping physically fit is known to have multiple general health benefits on top of improving heart health, such as reducing the risk of diabetes and even cancer.1 Perhaps even more importantly, now that we are living with COVID-19, being more rather than less active could potentially reduce the risk of falling severely ill if you’re unlucky enough to catch the causative virus.9
     
    Then there are the many benefits that physical activity can have on mental health:2,10,11

    improved mood

    Lower stress levels

    Reduced anxiety

    Improved sleep

    Better self-esteem

    Fewer cognitive problems


    Are there specific exercise benefits for people with schizophrenia?

    What about people living with schizophrenia? Well, studies have shown that exercise can help to improve schizophrenia symptoms.6,12
     
    Indeed, when used as part of a treatment plant that includes antipsychotic medication, then both positive and negative symptoms as well as cognition and quality of life have been shown to improve with moderate intensity exerises.5,6,12 This means that simple and inexpensive activities such as walking or riding a bike could be of benefit.2
     
    Don’t forget that any potential benefits on schizophrenia symptoms will be in addition to the benefits on developing comorbid diseases such as diabetes or heart disease, so for many people starting to exercise more and be less sedentary could be a win-win situation.5,12


    What type and how much exercise should you do?

    So, if exercise is good, how much should you do? The World Health Organization recommends that all adults should undertake weekly physical activity: 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity physical activity, or an equivalent combination of both.1 In addition, the WHO advises that moderate-intensity muscle-strengthening activities should be performed on two or more days of the week, and that these exercises should that involve all the major muscle groups.2
     
    That’s all very well, but of course this advice really needs to be individualised – someone who may not have exercised in a long time or who has done very little exercise, for example, should perhaps be more cautious than someone who has been regularly exercising for years.14
     
    Before staring any new exercise programmes, it’s therefore good practice to ask a doctor for their advice, just to ensure that you don’t overdo things or attempt things too quickly. There is also evidence to suggest that people with schizophrenia do better when they follow structured exercise programs under the guidance of a healthcare professional.15, 16


    Get active, stay active!

    Getting more active in your daily life can be as simple as taking a regular walk in the park, climbing the stairs rather than using the lift, or getting off the bus a stop early and walking. Exercise does not always mean that you need to go to a gym.
     
    Social support can be “a great motivator” according to the UK’s Mental Health Foundation.2 In their booklet ‘How to look after your mental health using exercise” they suggest “sharing your experiences, goals and achievements will help you to keep focus and enthusiasm.”2  The Foundation’s booklet also suggests tips for how to overcome barriers to exercising, such as attending a same-sex exercise class if you’re worried about body image.2
     
    There are lots of other good tips that can be found on the internet. Just remember that, according to the WHO, try to be less sedentary and some physical activity is better than none.

    References

    1. World Health Organization. World Health organization 2020 guidelines on physical activity and sedentary behavior, 2020. 
    2. Mental Health Foundation. Looking after your mental health using exercise
    3. Living With Schizophrenia. Exercise and schizophrenia
    4. Stubbs B, Firth J, Berry A, et alHow much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression. Schizophr Res. 2016:176(2–3):431–40.
    5. Firth J, Rosenbaum S, Stubbs B, et alMotivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychol Med. 2016;46(14):2869–81.
    6. Curcic D, Stojmenovic T, Djukic-Dejanovic S, et alPositive impact of prescribed physical activity on symptoms of schizophrenia: randomized clinical trial. Psychiatr Danub. 2017;29(4):459–65. 
    7. Rastad C, Martin C, Åsenlöf P. Barriers, benefits, and strategies for physical activity in patients with schizophrenia | physical therapy. Phys Ther. 2014;94(10):1467–79.
    8. Ho PA, Dahle DN, Noordsy DL. Why do people with schizophrenia exercise? a mixed methods analysis among community dwelling regular exercisers. Front Psychiatry. 2018;9: 596.
    9. Sallis R, Rohm Young D, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med. 2021;55(19):1099–1105. 
    10. NHS. Exercise for depression
    11. Mind. Physical activity and your mental health.
    12. Girdler SJ, Confino JE, Woesner ME. Exercise as a treatment for schizophrenia: a review.Psychopharmacol Bull. 2019;49(1):56–69.
    13. Chalfoun C, Karelis AD, Stip E, Abdel-Baki A. Running for your life: A review of physical activity and cardiovascular disease risk reduction in individuals with schizophrenia. J Sports Sci. 2016;34(16):1500–15.
    14. Viljoen M, Roos JL. RACGP – Physical exercise and the patient with schizophrenia. Aust J Gen Pract. 2020;49(12):803–8.
    15. Bueno-Antequera J, Munguía-Izquierdo D. Exercise and schizophrenia. Adv Exp Med Biol. 2020;1228: 317–32 .
    16. Girdler SJ, Confino JE, Woesner ME. Exercise as a treatment for schizophrenia: a review.Psychopharmacol Bull. 2019;49(1):56–69.
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