EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Eur Psychiatry. 2018 Oct:54:124-144. doi: 10.1016/j.eurpsy.2018.07.004.


Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes.

Keywords: Bipolar disorders; Exercise; Major depressive disorders; Physical activity; Psychosis; Schizophrenia; Sedentary behaviour; Severe mental illness.

Publication types

  • Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bipolar Disorder / psychology*
  • Cardiorespiratory Fitness
  • Depressive Disorder, Major / psychology*
  • Exercise / psychology*
  • Humans
  • Mental Health
  • Physical Therapists
  • Psychiatry
  • Psychotic Disorders / psychology*
  • Quality of Life
  • Schizophrenia*
  • Schizophrenic Psychology*
  • Societies, Medical
  • Societies, Scientific