People with mental illnesses such as schizophrenia, depression, and bipolar disorder die on average 10 to 20 years earlier than the general population. The main causes of this are cardiovascular and metabolic diseases, which are induced or exacerbated by lack of exercise. Now, an international team of scientists led by MedUni Vienna is calling for physical activity to be recognized as an integral part of psychiatric treatment, and also outlines concrete steps to successfully integrate it into practice. The review was published in a famous magazine JAMA Psychiatry.
This scientific publication, led by Brendon Stubbs (Center for Clinical Neuroscience and Mental Health and Department of Psychiatry and Psychotherapy, Medical University of Vienna), summarizes the results of hundreds of studies and meta-analyses, some involving more than 10,000 patients. Scientists have concluded that structured exercise produces moderate to large improvements in depression, psychotic symptoms, cognitive performance, quality of life, and cardiometabolic health, but systematic integration into psychiatric treatment is rare.
Lack of exercise as a symptom and risk factor
For example, people with schizophrenia spend an average of nearly 10 hours a day sitting, more time than almost any other population. Less than 20 percent of people meet the WHO recommendations of at least 150 minutes of moderate exercise or 75 minutes of vigorous physical activity per week. People with depression or bipolar disorder are up to 50% less likely to be fully active than other people. These patterns are not just symptoms of disease, but actively promote cardiometabolic disorders such as cardiovascular disease and diabetes. These can exacerbate inflammatory responses (neuroinflammation) in the brain, disrupt communication between nerve cells, and cause cognitive impairment. Furthermore, lack of exercise can worsen mental symptoms, creating a vicious cycle.
The biological mechanisms behind this are explained in a review. Physical inactivity disrupts the stress hormone system (HPA axis), increases inflammatory markers such as C-reactive protein and interleukin-6, impairs the dopamine reward circuit associated with motivation, among others, and reduces levels of BDNF (brain-derived neurotrophic factor), a protein important for brain health and mood. Exercise reverses many of these processes.
The evidence is clear. Physical activity is a safe, effective, and scalable treatment for people with severe mental illness. Psychiatric treatment without medication or psychotherapy is not acceptable. It’s time to apply the same standards to exercise. ”
Brendon Stubbs, Medical University of Vienna
This review describes how exercise can be successfully integrated into psychiatric care using the 5A model (Ask, Assess, Advise, Assist, Arrange). This allows mental health professionals to identify inactivity, assess readiness to change behavior, provide personalized recommendations, support motivation and goal setting, and make progress checks and follow-up appointments, all within a regular clinical visit. Dr. Stubbs: “The significantly reduced life expectancy of people with severe mental illness is one of the most shameful inequalities in modern medicine. Exercise is not a panacea, but it has been proven to really help reduce this inequality, and it has proven to be a cost-effective tool that is available to everyone.”
sauce:
Medical University of Vienna
Reference magazines:
Stubbs, B. Others. (2026). Incorporating physical activity into routine psychiatric care. JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2026.0026. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2845751
