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

Abstract

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.

Role of advanced glycation end products in the longitudinal association between muscular strength and psychotic symptoms among adolescents

“…Puberty is a critical period of significant muscle development, and underdevelopment during this period can affect the brain and body. Taken together, our findings highlight the importance of the muscle-brain axis, which is further supported by a recent review summarizing the effect of exercise in protecting mental health in youth at risk for psychosis 21 . Additionally, another review indicated that muscle-induced peripheral factors enable direct crosstalk between muscle and brain function 22 .…”

Physical Exercise and Mental Health: The Routes of a Reciprocal Relation

“…Physical activity is a protective factor against incident psychosis in the general population [ 41 ] and young people at high risk for psychosis [ 42 ]. Moreover, exercise represents a promising new treatment option, in addition to drugs and psychosocial interventions, for psychosis.…”

Perspectives of mental health clinicians on physical health of young people with early psychosis

“…While the sedating effects and metabolic disturbances associated with antipsychotic medications and the impact of sedentary lifestyle have been widely recognised (Firth et al., 2019, 2020), our results identified that clients' illness experience, including symptoms of psychosis with or without the exacerbation of the side effects of antipsychotic medications, has led to a dimensional impact on their level of motivation, ability to participate in daily living and self‐care, and ability to seek and access help and their social well‐being. Participants found that their clients often struggle to maintain own health and well‐being and difficulty to remain engaged with their clinicians due to the lack of motivation.…”