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Review
. 2022 Jun;272(4):643-677.
doi: 10.1007/s00406-021-01360-x. Epub 2021 Dec 6.

Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine

Peter Falkai  1 , Andrea Schmitt  1   2 , Christian P Rosenbeiger  1 , Isabel Maurus  3 , Lisa Hattenkofer  1 , Alkomiet Hasan  4 , Berend Malchow  5 , Pascale Heim-Ohmayer  6 , Martin Halle  6   7 , Melanie Heitkamp  6
Affiliations
Review

Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine

Peter Falkai et al. Eur Arch Psychiatry Clin Neurosci. 2022 Jun.

Abstract

Major depression, bipolar disorder, and schizophrenia are severe mental illnesses. Despite receiving psychopharmacological and psychosocial treatments, about half of patients develop a chronic course with residual cognitive and negative symptoms and have a high risk for cardiovascular disease and reduced life expectancy. Therefore, add-on innovative treatment approaches are needed to improve outcome. Aerobic exercise interventions have been shown to improve global functioning, cognition, and negative and depressive symptoms in these patients. The basic mechanism of these exercise-related changes has been reported to be improved brain plasticity, e.g., increased volume of disease-related brain regions such as the hippocampus. The optimal type, duration, and frequency of exercise have not yet been determined and need to be addressed in supervised physical exercise studies. Because of the low physical activity levels, lack of drive related to negative and depressive symptoms, and high prevalence of cardiovascular comorbidities in patients with severe mental illness, besides aiming to improve symptoms of mental illness, exercise interventions should also aim to increase cardiorespiratory fitness, which they should comprehensively assess by direct measurements of maximal oxygen uptake. Based on the recommendations for developing cardiorespiratory fitness by the American College of Sports Medicine, 150 min moderate-intensity training per week or vigorous-intensity exercise training for 75 min per week are appropriate. Most studies have had relatively short intervention periods, so future studies should focus on long-term adherence to exercise by implementing motivational strategies supported by telemedicine and by identifying and targeting typical barriers to exercise in this patient population.

Keywords: Aerobic exercise; Bipolar disorder; Cardiorespiratory fitness; Major depression; Neuroplasticity; Physical activity; Schizophrenia.

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Conflict of interest statement

C.P. Rosenbeiger, I. Maurus, B. Malchow, L. Hattenkofer, P. Heim-Ohmayer, M. Halle, and M. Heitkamp report no conflicts of interest. A. Hasan has been invited to scientific meetings by Lundbeck, Janssen, and Pfizer, and he received paid speakerships from Janssen, Otsuka, and Lundbeck. He was member of Roche, Otsuka, Lundbeck, and Janssen advisory boards. A. Schmitt was an honorary speaker for TAD Pharma and Roche and a member of Roche advisory boards. P. Falkai has been an honorary speaker for AstraZeneca, Bristol Myers Squibb, Lilly, Essex, GE Healthcare, GlaxoSmithKline, Janssen Cilag, Lundbeck, Otsuka, Pfizer, Servier, and Takeda and has been a member of the advisory boards of Janssen-Cilag, AstraZeneca, Lilly, and Lundbeck.

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