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

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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 (meta-analyses = 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.

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Data Availability Statement

As this article is a review, the data can be found within each article referenced (see References list below).

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Authors and Affiliations

  1. South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK

    Garcia Ashdown-Franks & Brendon Stubbs

  2. Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK

    Garcia Ashdown-Franks & Brendon Stubbs

  3. Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada

    Garcia Ashdown-Franks & Brendon Stubbs

  4. NICM Health Research Institute, Western Sydney University, Westmead, Australia

    Joseph Firth

  5. Division of Psychology and Mental Health, University of Manchester, Manchester, UK

    Joseph Firth

  6. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Joseph Firth

  7. Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK

    Rebekah Carney

  8. Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada

    Andre F. Carvalho

  9. Unit of Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCS), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Mats Hallgren

  10. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain

    Ai Koyanagi

  11. School of Psychiatry UNSW, Sydney, Australia

    Simon Rosenbaum

  12. Black Dog Institute, Sydney, Australia

    Simon Rosenbaum

  13. Department of Methods and Sports Techniques, Universidade Federal de Santa Maria, Santa Maria, Brazil

    Felipe B. Schuch

  14. The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  15. Neurosciences Department, University of Padova, Padua, Italy

    Marco Solmi

  16. Department of Rehabilitation Sciences, KU Leuven, Louvain, Belgium

    Davy Vancampfort

  17. UPC KU Leuven, Leuven-Kortenberg, Belgium

    Davy Vancampfort

Authors
  1. Garcia Ashdown-Franks
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  2. Joseph Firth
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  3. Rebekah Carney
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  4. Andre F. Carvalho
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  5. Mats Hallgren
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  6. Ai Koyanagi
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  7. Simon Rosenbaum
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  8. Felipe B. Schuch
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  9. Lee Smith
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  10. Marco Solmi
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  11. Davy Vancampfort
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  12. Brendon Stubbs
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Contributions

BS, JF and DV designed the review. BS, AK, MH, JF, FS, GA-F, MS, SR and RC conducted the literature searches and extracted the data. BS, JF, DV and GA-F wrote the paper. All authors provided critical comments, approved the final version and meet the criteria for authorship.

Corresponding author

Correspondence to Brendon Stubbs.

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Funding

Brendon Stubbs holds a Clinical Lectureship supported by Health Education England and the NIHR Integrated Clinical Academic (ICA) Programme (ICA-CL-2017-03-001). Brendon Stubbs is also part supported by the Maudsley Charity and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author[s] and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. John Firth is supported by a Blackmores Institute Fellowship. Rebekah Carney is funded by the Research Capability Fund via Greater Manchester West Mental Health NHS Foundation Trust. Garcia Ashdown-Franks is funded by a Mitacs Globalink Research Award.

Conflict of interest

Garcia Ashdown-Franks, Joseph Firth, Rebekah Carney, Andre Carvalho, Mats Hallgren, Ai Koyanagi, Simon Rosenbaum, Felipe Schuch, Lee Smith, Marco Solmi, Davy Vancampfort and Brendon Stubbs declare that they have no conflicts of interest relevant to the content of this review.

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Ashdown-Franks, G., Firth, J., Carney, R. et al. Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes. Sports Med 50, 151–170 (2020). https://doi.org/10.1007/s40279-019-01187-6

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