Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Brokmeier, Luisa Leonie; Firth, Joseph; Vancampfort, Davy; Smıth, Lee; Deenik, Jeroen; Rosenbaum, Simon; Stubbs, Brendon; Schuch, Felipe Barreto

doi:10.1016/j.psychres.2019.112675

Cited by 33 publications

(30 citation statements)

References 40 publications

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“…The COVID-19 pandemic appears to have impacted mental health globally, increasing rates of depression and anxiety symptoms and disorders 5 . On the other hand, those more active are less likely to develop mental disorders 26-28 and reported fewer symptoms in comparison to those with mental disorders 29-32 . During the pandemic, cross-sectional evidence suggests that those with higher PA or lower SB levels are less likely to present depressive symptoms 33 .…”

Section: Discussionmentioning

confidence: 94%

Moderate to vigorous physical activity and sedentary behavior change in self-isolating adults during the COVID-19 pandemic in Brazil: A cross-sectional survey exploring correlates

Schuch

Bulzing

Meyer

et al. 2020

Preprint

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Background: The self-distancing measures imposed major changes in daily life routine. This study aimed to (i) evaluate the changes (pre-versus during pandemic) in time spent in moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in selfisolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates of MVPA and SB. Methods: A cross-sectional self-report online survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic. Sociodemographic, behavioral, clinical, variables, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Results: A total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95%CI:35.6 to 82.2) in time spent on MVPA during the pandemic. Time spent in SB increased 42.0% (95%CI:31.7 to 52.5). Greater reductions in MVPA and/or increases in SB were seen in younger adults, those not married, those employed and those with a self-reported previous diagnosis of a mental disorder. Conclusions: People in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies should be implemented during epidemic times to mitigate the impact of self-isolation on MVPA and SB, particularly in vulnerable groups.

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Section: Discussionmentioning

confidence: 94%

Moderate to vigorous physical activity and sedentary behavior change in self-isolating adults during the COVID-19 pandemic in Brazil: A cross-sectional survey exploring correlates

Schuch

Bulzing

Meyer

et al. 2020

Preprint

Self Cite

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“…One meta-analysis examined prospective associations of physical activity with schizophrenia and related psychotic disorders 38 . Across five prospective comparisons, with 4-32 years of follow-up, higher levels of physical activity significantly reduced risk of incident psychosis (OR=0.728, 95% CI: 0.532-0.995, I 2 =36.9%).…”

Section: Physical Activity and Risk Of Psychotic And Bipolar Disordersmentioning

confidence: 99%

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

et al. 2020

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There is increasing academic and clinical interest in how “lifestyle factors” traditionally associated with physical health may also relate to mental health and psychological well‐being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta‐review of the top‐tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta‐analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta‐reviews, and two meta‐analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress‐related disorders, schizophrenia, bipolar disorder, and attention‐deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non‐pharmacological sleep‐focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.

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“…While there is limited direct evidence from exercise studies in ‘clinical high risk’ (CHR) samples, accumulating findings from a variety of sources suggests considerable promise. First, investigators have observed that physical activity is a protective factor against incident psychosis in the general population (Brokmeier et al, 2020 ) .Further, data from the Northern Finland 1966 Birth Cohort demonstrate that adolescents (at age 14) with parental psychosis ( i.e ., the first generation of high-risk studies focused on those at familial or genetic high-risk) that were engaged at physical activity at least once every two days were 24% less likely to develop psychosis compared to those at equivalent genetic risk that performed physical activity less than once per week (Keskinen et al, 2018 ).…”

Section: The Existing Evidence For Physical Activity and Exercise As mentioning

confidence: 99%

Using exercise to protect physical and mental health in youth at risk for psychosis

Firth

Schuch

Mittal

2020

ResPsy

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A large body of literature has demonstrated that exercise interventions can improve a broad range of outcomes in people with established schizophrenia, including reducing psychiatric symptoms, increasing cognitive functioning, and improving physical health. Furthermore, these benefits seem just as pronounced in first-episode psychosis. However, there have been few clinical studies to date examining the effects of exercise in those found to be ‘at-risk’ of psychosis, particularly for those meeting the criteria for ‘Clinical High Risk’ (CHR) state (a classification which includes both those meeting the ‘ultra-high risk for psychosis’ criteria and/or those with ‘atrisk mental states’). This is surprising, as a proportion of those in the CHR state go on to develop psychotic disorders, and a growing body of evidence suggests that early interventions in this period have significant potential to improve the course of illness. In this article, we shall review the existing literature for i) exercise as an adjunctive intervention for those treated for psychosis; ii) exercise as a standalone intervention in CHR groups; and iii) the rationale and supportive evidence for widescale use of exercise to preserve physical and mental health in those identified as at risk for psychosis. From this, we will put forth how the CHR phase represents an under-researched but highly-suitable timepoint for administering structured exercise interventions, in order to improve physical, psychological and neurocognitive outcomes; while also potentially reducing the odds of transition to full-threshold psychotic disorders. Following this, directions, recommendations and considerations around both the clinical implementation and future research around exercise in CHR individuals will be discussed.

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Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Abstract: Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies,

Cited by 33 publications

References 40 publications

Moderate to vigorous physical activity and sedentary behavior change in self-isolating adults during the COVID-19 pandemic in Brazil: A cross-sectional survey exploring correlates

Moderate to vigorous physical activity and sedentary behavior change in self-isolating adults during the COVID-19 pandemic in Brazil: A cross-sectional survey exploring correlates

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

Using exercise to protect physical and mental health in youth at risk for psychosis

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