Clinical, But Not Subclinical, Psychosis Linked with Less Physical Activity

Low physical activity was defined as less than 150 minutes of moderate-to-vigorous exercise per week.

According to a recent meta-analysis of 20 studies, approximately 90 minutes of moderate-to-vigorous weekly physical activity can improve multiple physical and mental health issues in people with schizophrenia, a population that typically has high levels of sedentary behavior.1 

Exercise has been shown to reduce the risk of cardiovascular disease, premature death, psychiatric symptoms, neurocognition, and comorbidities in these patients. Additionally, a new study published in Schizophrenia Bulletin found that those with higher levels of physical activity had faster motor reaction times and processing speed and better attention (P < .05) compared to patients with more sedentary behavior.2

Published by the same journal, another new study conducted by researchers from multiple international universities, examined the relationship between amount of exercise and subclinical and clinical psychosis in 204 816 adult patients from 46 low-and middle-income countries.3 Based on participants’ reporting of any previous psychosis diagnosis and answers to questions about psychotic symptoms, researchers assigned them to one of 3 groups: psychosis diagnosis, psychotic symptoms with no diagnosis (subclinical), and controls with no psychotic symptoms or diagnosis. They also assessed numerous measures of health, as well as depression according to DSM-IV criteria. Low physical activity was defined as less than 150 minutes of moderate-to-vigorous exercise per week.

While no difference was observed between the subclinical group and controls, the results show higher odds of reduced physical activity among patients with a psychosis diagnosis (OR = 1.36; 95% confidence interval (CI) = 1.04-1.78; P = .024), especially in males (OR = 2.29; 95% CI = 1.57-3.34; P < .0001). 

In mediational analyses to determine factors influencing this association, the most significant mediators were mobility (18.5%), self-care difficulties (16.3%), depression (16.1%), cognition (11.8%), pain and discomfort (11.4%), interpersonal activities (8.6%), sleep and energy (7.2%), and vision (3.0%).

The authors suggest strategies that may help increase patients’ levels of physical activity, including continuing medical education for healthcare providers regarding the benefits of exercise for patients with psychosis, and training of primary care providers to deliver simple interventions. 

Future research should investigate a potential role for such interventions in preventing and treating psychiatric disorders. “Given the large numbers of people affected by psychosis, and the increased associated morbidity, investment in trained public health professionals and resources (including infrastructure) to increase physical activity in daily life for people with psychosis may offer excellent value, both economically and from a mental and physical health perspective,” the authors concluded.

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1. Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015; 45(7):1343-61.

2. Stubbs B, Ku P, Chung M, Chen, L. Relationship between objectively measured sedentary behavior and cognitive performance in patients with schizophrenia vs controls. Schizophr Bull. 2016; doi: 10.1093/schbul/sbw126

3. Stubbs B, Koyanagi A, Schuch F, et al. Physical activity levels and psychosis: A mediation analysis of factors influencing physical activity target achievement among 204,186 people across 46 low- and middle-income countries. Schizophr Bull. 2016; doi:10.1093/schbul/sbw111