Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes

Abstract

Background Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression). Methods Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+. Results Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (metaanalyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported. Conclusion Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

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

“…One recent meta-review provided sufficient information on the efficacy of physical activity for the treatment of eligible psychiatric conditions, bringing together the data from 16 meta-analyses of RCTs 77 . The most widely assessed condition was major depression, with four meta-analyses in adult samples finding significant positive effects of exercise interventions in comparison to various control conditions, including waitlist and usual treatment, control interventions of flexibility, stretching/ relaxation and meditation, and placebo pills.…”

“…Concerning the treatment of anxiety and stress-related disorders, the most recent meta-analyses found that exercise reduced symptoms significantly more than control conditions in pooled analyses of RCTs in patients with panic disorder, generalized anxiety disorder, post-traumatic stress disorder and social phobia (n=6, N=262, SMD=-0.581, 95% CI: -1.09 to -0.076, I 2 =66%) and in people receiving treatment for anxiety in primary care (n=4, SMD=-0.32, 95% CI: -0.62 to -0.01). However, an earlier meta-analysis found inconsistent evidence for significant benefits, with the effects of exercise on anxiety disorders varying with regard to the type of control condition used 77 .…”

Chronic environmental or genetic elevation of galanin in noradrenergic neurons confers stress resilience in mice

“…worldwide, yet current pharmacological treatments have limited efficacy and cause adverse side effects for many people (Nestler et al, 2002;Rush et al, 2006;James et al, 2018). Clinical studies have consistently linked physical exercise to improvements in a wide array of neuropsychiatric disorders (Herring et al, 2010;Cooney et al, 2013;Ashdown-Franks et al, 2020). Individuals who regularly exercise are less likely to experience stress-related neuropsychiatric disorders, such as depression, anxiety, and post-traumatic stress disorder (Whitworth and Ciccolo, 2016;Chekroud et al, 2018;Harvey et al, 2018), and chronic voluntary wheel running increases resilience to various stressors in rodents (Sciolino et al, 2012;Kingston et al, 2018;Mul et al, 2018;Tanner et al, 2019).…”

Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies

“…In addition, regular physical activity is found to alleviate symptoms of anxiety and depression (Fox, ; Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, ; Stubbs et al, ). Such effects may be explained both neurobiological, psychosocial, and behavioral changes (Ashdown‐Franks et al, ; Lubans et al, ; Mullen & Hall, ). If physical activity is included in the treatment of BN and BED, such changes may be relevant to expect as both disorders are acknowledged as cognitive and neurobiological in nature (Donnelly et al, ; Grant & Chamberlain, ).…”