In this era of exponential growth in “metabolic syndrome” and obesity, lifestyle modifications may be a cost-effective way to improve health and quality of life. Lifestyle modifications may be of great importance for people with serious mental illness. Many of these individuals are at high risk for chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease. 1 Exercise is an essential component of lifestyle modification. The importance of exercise is not adequately understood or appreciated by patients and mental health professionals. Evidence suggests that exercise may be an often overlooked intervention in mental health care. 2
Aerobic exercise, including jogging, swimming, cycling, walking, gardening, and dancing, has been shown to reduce anxiety and depression. 3 These mood improvements are proposed to be caused by exercise-induced increases in blood flow to the brain and an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, therefore, physiological reactivity to stress. 3 This physiological influence is likely mediated by communication of the HPA axis with several brain regions, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important role in memory formation as well as mood and motivation.
Other hypotheses have been proposed to explain the beneficial effects of physical activity on mental health, including distraction, self-efficacy, and social interaction. 4 Although structured group programs may be effective for people with serious mental illness, lifestyle changes focused on accumulating and increasing moderate-intensity activities throughout the day may be most appropriate for most patients. 1 Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population.
Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function. 2 Exercise has also been found to relieve symptoms such as low self-esteem and social withdrawal. 3 Exercise is particularly important in patients with schizophrenia because these patients are already at risk for obesity and also because of the added risk of weight gain associated with antipsychotic treatment, particularly with atypical antipsychotics. Patients with schizophrenia who participated in a 3-month fitness program showed improvements in weight control and reported increased fitness, exercise tolerance, reduced blood pressure, increased perceived energy levels, and increased upper body and hand grip strength levels. 5 Thirty minutes of moderate-intensity exercise, such as brisk walking 3 days per week, is sufficient for these health benefits. Additionally, these 30 minutes do not need to be continuous; three 10-minute walks are thought to be as helpful as one 30-minute walk.
The health benefits of regular exercise that should be emphasized and reinforced by every mental health professional to their patients include:
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Improved sleep
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Increased interest in sex
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Better endurance
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Relaxation
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Improved mood
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Increased energy and endurance
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Reduced fatigue which can increase mental alertness
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Weight reduction
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Reduction of cholesterol and improvement of cardiovascular condition
Mental health service providers can thus offer effective, evidence-based physical activity interventions to people with serious mental illness. Further studies should be conducted to understand the impact of combining these interventions with traditional mental health treatments, including psychopharmacology and psychotherapy.
